Eyeworld

EW NEWS & OPINION 34 April 2017 Research highlight by Maxine Lipner EyeWorld Senior Contributing Writer the corneal blindness in children. "In the Philippines and two centers in India, we compared povidone– iodine against the most commonly used antibiotics in the country," Dr. Isenberg said, adding that for the Philippines this was an antibiotic that was equivalent to a neomycin/ polymyxin/bacitracin combination like Neosporin (Johnson & Johnson, New Brunswick, New Jersey), and for India, ciprofloxacin was used. The idea was to use the antibiotics that were in use in each of these countries, he explained. Results were promising. "The bottom line was povidone–iodine was just as good essentially if not better," he said. "In some ways, it was better, and in others it was just as good at far less cost." One area where there was a bit of improvement over the antibiotics studied here involved the mean days to healing, but there wasn't a huge difference," Dr. Isenberg noted. Developing world advantages One of the most important advan- tages, however, is the availability of povidone–iodine in many develop- ing countries, he stressed. For exam- ple, you may be in the frontier in India where you can't get ciproflox- acin; however, there is povidone– iodine available as a powder or a liquid for sterilizing hands, surgical fields, and instruments for surgery, Dr. Isenberg said, adding that it is also very cost effective. "A pharma- cy can put it together for about $1 U.S.," he said. Meanwhile, in treating keratitis, a lot of drops are needed. Patients often have to use drops every hour around the clock for up to 3 days. "For under $10, you could treat a person's complete infection," Dr. Is- enberg said, adding that the concept was actually only to treat some in a remote location with povidone–io- dine until they could reach a city center where antibiotics are avail- able. He cites somebody who may live a couple of days travel from Ma- nila in the Philippines. "If they can get started on the povidone–iodine instead of not treating at all until getting to the center, at a minimum that's greatly advantageous," Dr. Isenberg said. Overall, Dr. Isenberg hopes practitioners come away from the study with the understanding that plant," Dr. Isenberg said, adding that in developing countries it's a dif- ferent story because antibiotics are often not available. As a result, pa- tients may be treated with nothing. What's more, a corneal transplant is usually not an option. Multiple povidone–iodine uses With that in mind, investigators were searching for another option. Having studied povidone–iodine previously as a preventative agent, this seemed a natural. "We have a long history with povidone–iodine," Dr. Isenberg said. "My senior associ- ate Leonard Apt, MD, who passed away 2 years ago, and I began inves- tigating this in a different context. In the 1980s, we asked the question of how to best sterilize eyes before surgery." Until that time, there was no science on how to prepare and sterilize eyes before surgery, he added. "We actually published the first scientific control papers on povidone–iodine," Dr. Isenberg said, adding that this was in the context of how to best sterilize eyes before surgery. The povidone–io- dine proved remarkably effective in this context. "In those studies, we achieved the greatest sterility levels and the lowest bacterial counts ever on the eyes," he said. "It still hasn't been beaten." Around the world po- vidone–iodine continues to be used before ocular surgery, Dr. Isenberg stressed. 2 In addition, Dr. Isenberg and Dr. Apt also previously studied use of povidone–iodine in eyes of new- borns in place of the two most com- monly used drops in the world at that time, which were silver nitrate and erythromycin. In that study conducted in Kenya, they found that povidone–iodine was as good, if not better than these for prevent- ing ophthalmia neonatorum, also known as congenital conjunctivitis. 3 "Because of those studies and a few subsequent ones, in many parts of the world now povidone–iodine is used in newborns right at birth," Dr. Isenberg said. They later also proved that this was effective against bac- terial and chlamydial conjunctivitis but not effective against viruses, he continued. 4 The next step was to see wheth- er it could also be effective against keratitis, known to cause most of currently in use in the developing world. 1 Worldwide there are more than 1.5 million blind children, Dr. Isenberg points out. "Of those, the World Health Organization has calculated that about 400,000 are blind from corneal disease, which means essentially they're blind from corneal scarring," he said. "In most parts of the developing world, it is the number one cause of prevent- able blindness in children." Traditionally in developed countries, heavy doses of antibiot- ics are the mainstay for combating such corneal disease. "It's not always curative, but if it's not curative, then the patient can have a corneal trans- Expanding povidone- iodine's reach I n developing areas of the world, use of povidone–iodine may be a viable, less costly alterna- tive to antibiotics, according to Sherwin J. Isenberg, MD, Lorraine and David Gerber professor of ophthalmology, Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles. Results from a recent study published in the American Journal of Ophthalmology indicate that treatment of bacterial keratitis with topical povidone–iodine 1.25% was comparable to those antibiotics Quelling infectious blindness in developing countries A large bacterial corneal ulcer as it presented in India. It healed with a resultant large scar after treatment with povidone-iodine ophthalmic solution. A smaller corneal ulcer caused by Pseudomonas as it presented in Manila. After treatment with povidone-iodine ophthalmic solution for 14 days, only a faint superficial scar remained. Source (all): Sherwin J. Isenberg, MD continued on page 36

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