A randomised trial of povidone-iodine to reduce visual impairment from corneal ulcers in rural Nepal.
OBJECTIVE
To assess whether povidone-iodine provided any benefit over and above a standard regimen of antibiotic therapy for the treatment of corneal ulcers.


METHODS
All patients diagnosed with corneal ulcers presenting for care at a primary eye care clinic in rural Nepal were randomised to a standard protocol of antibiotic therapy versus standard therapy plus 2.5% povidone-iodine every 2 hours for 2 weeks. The main outcomes were corrected visual acuity and presence, size, and position of corneal scarring in the affected eye at 2-4 months following treatment initiation.


RESULTS
358 patients were randomised and 81% were examined at follow up. The two groups were comparable before treatment. At follow up, 3.9% in the standard therapy and 6.9% in the povidone-iodine group had corrected visual acuity worse than 20/400 (relative risk (RR) 1.77, 95% confidence interval (CI) 0.62 to 5.03). 9.4% in the standard therapy and 13.1% in the povidone-iodine group had corrected visual acuity worse than 20/60 (RR 1.39, 95% CI 0.71 to 2.77), and 17.0% and 18.8% had scars in the visual axis in each of these groups, respectively (RR 1.11, 95% CI 0.67 to 1.82).


CONCLUSIONS
A small proportion of patients with corneal ulceration treated in this setting had poor visual outcomes. The addition of povidone-iodine to standard antibiotic therapy did not improve visual outcomes, although this design was unable to assess whether povidone-iodine on its own would have resulted in comparable visual outcomes to that of standard therapy.
Katz
J
J
Johns Hopkins Bloomberg School of Public Health, Division of Disease Prevention and Control, Department of International Health, Room W5009, 615 N Wolfe Street, Baltimore, MD 21205-2103, USA. jkatz@jhsph.edu
Khatry
S K
SK
Thapa
M D
MD
Schein
O D
OD
Kimbrough Pradhan
E
E
LeClerq
S C
SC
West
K P
KP
D000293:Adolescent; D000328:Adult; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002648:Child; D003320:Corneal Ulcer / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007466:Iodophors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D011206:Povidone-Iodine / Q000627:therapeutic use*; D016896:Treatment Outcome; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014792:Visual Acuity / Q000502:physiology
D000891:Anti-Infective Agents, Local; D007466:Iodophors; D011206:Povidone-Iodine