Effectiveness of Intraoperative 0.25% Povidone-iodine Irrigation during Cataract Surgery for Prevention of Postoperative Endophthalmitis

Abstract

Background and objective:  Cataract is a major cause of treatable blindness, while postoperative endophthalmitis, although rare, is a severe complication. The objective of this study was to evaluated the safety and clinical outcomes of intraoperative 0.25% povidone-iodine irrigation during cataract surgery for prevention of postoperative endophthalmitis. Methods: A retrospective review of medical records was conducted in patients who underwent cataract surgery between January 1, 2021, and March 30, 2025, with intraoperative irrigation using 0.25% povidone-iodine solution. Data were analyzed using descriptive statistics. Results: A total of 838 patients were included with mean age 66.9 ± 9.6 years, most were female (56.9%). The majority underwent phacoemulsification with intraocular lens implantation (97.6%). On postoperative day 1, anterior chamber inflammation graded 1+, 2+ and 3+ were observed in 28.6%, 60.0% and 11.4%, respectively, decreasing to trace in 99.5% within 7 days. The mean time to absence of inflammation was 32.9 ± 6.9 days. No postoperative endophthalmitis was detected during mean follow-up of 9.9 ± 6.0 months. Postoperative visual acuity of 6/12 or better was achieved in 77% of patients after 6 months of surgery. Conclusions: The intraoperative use of 0.25% povidone-iodine solution during cataract surgery demonstrated a favorable safety profile and acceptable clinical outcomes, with no cases of postoperative endophthalmitis observed during the follow-up period. However, as this study did not include a comparison group, it could not determine whether the preventive effect against postoperative endophthalmitis differed from that of no prophylactic use or other preventive approaches.