Povidone-iodine in the treatment of infectious keratitis: A systematic review

Purpose

To evaluate if povidone-iodine (PI) is effective and safe in the treatment of infectious keratitis.

Design

Systematic review.

Methods

A systematic review of Ovid MEDLINE, EMBASE, and Cochrane Library was conducted to find relevant published articles. Outcomes including best corrected visual acuity, infiltrate, ulcer size and colony forming units (CFUs) were collected. All randomized clinical trials (RCTs) and observational studies published in English were included.

Results

A total of 221 articles were identified. After screening of titles and abstracts, 15 articles underwent full-text review. Three RCTs, one cohort and four case reports met the inclusion criteria. In one study, PI was shown to be an effective treatment in reducing infiltrate and ulcer size while waiting for culture results. Another study found no significant difference between PI and antibiotic treatment in achieving recovery and presumed cure. However, two other studies reported that PI did not significantly reduce CFU or improve visual outcomes when added to standard antibiotic treatment. None of the studies reported any safety concerns with topical PI.

Conclusions

Some studies suggest that PI may have potential benefits in the management of infectious keratitis, while others found no significant differences relative to placebo or when added to topical antibiotic treatment. . The current evidence is limited by small sample sizes and heterogeneity in study design, populations, outcome measures, and PI concentrations. RCTs with a larger sample size, and standardized PI concentrations, durations, and outcome measures are recommended to confirm the efficacy of PI in the treatment of infectious keratitis.