After preoperative conjunctival and periorbital antisepsis with povidone-iodine (PVP-I), the systemic absorption of iodine after cataract surgery was measured to evaluate the risk of thyroid side effects. Five different combinations of PVP-I alone or in combination with PVP-I-free antiseptics were applied to the conjunctiva and periorbital skin. An iodine-free product served as control. Iodide and creatinine in urine were analyzed before intervention and 24 and 48 h postoperatively. Depending on the concentration and application site, 0.3–4.5% of the total applied iodine or 3.6–45.4% of the free iodine were absorbed. The range of urine iodine excretion was between 11.7 and 71.0 µg iodine/g creatinine, depending on the PVP-I concentration and the site of application. The increase in iodine excretion was significant at 24 h postoperatively in trials receiving PVP-I both periorbitally and conjunctivally, depending of the concentration used. Because the iodine absorption is only slight and of doubtful clinical relevance, presurgical conjunctival antisepsis can be achieved with 1.25% PVP-I; so far clinically manifest anamnestic thyroid disorders are excluded. Presently, periorbital skin antisepsis with PVP-I cannot be recommended until data on thyroid metabolism in the population have been collected and evaluated, especially in a region currently or previously deficient in iodine.

Keywords:
Eye antisepsis, Systemic absorption, povidone-iodine, Thyroid function
1.
Kramer A, Behrens-Baumann W: Antisepsis versus antimicrobial chemotherapy and indications for eye antisepsis; in Kramer A, Behrens-Baumann W (eds): Antiseptic Prophylaxis and Therapy in Ocular Infections. Basel, Karger, 2002, pp 14–27.
2.
Behrens-Baumann W, Augustin AJ, Dick B, et al: Guidelines on prophylaxis and therapy of endophthalmitis. Hyg Med 2003;28:447–459.
3.
Speaker MG, Binder CA, Menikoff JA: Prophylaxis of endophthalmitis with topical povidone-iodine. Ophthalmology 1991;98:1769–1775.
4.
Kranabitl HP, Bichler A: Prophylaxe der Ophthalmia neonatorum. Hyg Monitor 2001;7:2–3.
5.
Isenberg SJ, Apt L, Campeas D: Ocular application of povidone-iodine. Dermatology 2002;204(suppl1):92–95.
6.
Isenberg SJ, Apt L, Valenton M, Del Signore M, Cubillan L, Labrador MA, et al: A controlled trial of povidone-iodine to treat infectious conjunctivitis in children. Am J Ophthalmol 2002;134:681–688.
7.
Hansmann F, Kramer A, Ohgke H, Strobel H, Geerling G: Polyhexamethylbiguanid (PHMB) zur präoperativen Antisepsis bei Kataraktoperation. Ophthalmologe 2004;101:377–383.
8.
Miňo de Kaspar H, Engelbert M, Klauss V, Kampik A: Colonization of the conjunctiva with Propionibacterium acnes before and after application of povidone iodine before intraocular surgery. Ophthalmologe 1998;95:438–441.
9.
Binder CA, Miňo de Kaspar H, Klauss V, Kampik A: Preoperative infection prophylaxis with 1% povidone-iodine solution based on the example of conjunctival staphylococci. Ophthalmologe 1999;96:663–667.
10.
Hara J, Yasuda F, Higashitsutsumi M: Preoperative disinfection of the conjunctival sac in cataract surgery. Ophthalmologica (Basel) 1997;211(suppl 1):62–67.
11.
Isenberg SJ, Apt L, Valenton M, Del Signore M, Cubillan L, Labrador MA, et al: A controlled trial of povidone-iodine to treat infectious conjunctivitis in children. Am J Ophthalmol 2002;134:681–688.
12.
Wilhelm F, Jendral G, Bredehorn T, Dunker G, Wilhelms D, Kramer A: Antimicrobial decontamination of corneal donor material: infection prevention and quality assurance. Ophthalmologe 2001;98:143–146.
13.
Müller G, Kramer A: In vitro action of combinations of selected antimicrobial agents and adult bovine articular cartilage (sesamoid bone). Chem Biol Interact 2003;145:331–336.
14.
Bolton L, Oleniacz W, Constantine B, et al: Repair and antibacterial effects of topical antiseptic agents in vivo; in Maibach H, Lowe I (eds): Models in Dermatology 2. Basel, Karger, 1985, pp 145–158.
15.
Rudolph P, Reimer K, Mlynski G, Reese M, Kramer A: Nose compatibility of local antiinfectives – An in vitro model using ciliated epithelium. Hyg Med 2000;25:500–503.
16.
Kramer A, Below H, Behrens-Baumann W, Müller G, Rudolph P, Reimer K: New aspects of the tolerance of the antiseptic povidone-iodine in different ex vivo models. Dermatology 2001;204(suppl 1):86–91.
17.
Kramer A, Behrens-Baumann W: Prophylactic use of topical anti-infectives in ophthalmology. Ophthalmologica (Basel) 1997;211(suppl 1):68–76.
18.
Behrens-Baumann W, Augustin AJ, Dick B, Fabian E, Huber-Spitzy V, Klauss V, Kramer A, Pitten F-A, Pleyer U, Zeitz J: Leitlinie zur Prophylaxe und Therapie von Endophthalmitiden. Hyg Med 2003;28:447–459, revised version 2005;30:342–362.
19.
Bauch K: Epidemiology of functional autonomy. Exp Clin Endocrinol Diabetes 1998;106(suppl 4):16–22.
20.
Völzke H, Lüdemann J, Robinson DM, Spieker KW, Schwahn C, Kramer A, John U, Meng W: The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area. Thyroid 2003;13:803–810.
21.
Stanbury JB, Ermans AE, Bourdoux P, Todd C, Oken E, Tonglet R, Vidor G, Braverman LE, Medeiros NG: Iodine-induced hyperthyroidism: occurrence and epidemiology. Thyroid 1998;8:83–100.
22.
Sandell EB, Kolthoff IM: Chronometric catalytic method for the determination of micro quantities of iodine. J Am Chem Soc 1934;56:1426.
23.
Sandell EB, Kolthoff IM: Micro determination of iodine by a catalytic method. Mikrochim Acta 1937;1:9–25.
24.
Lorenz-Wawschinek O, Tiran B, Eber O, Langsteger W: Photometric determination of iodine in urine. Exp Clin Endocrinol 1994;102:57–58.
25.
Zöllner H, Kramer A, Hampel R: Screening for deficiency of iodine (in German). GIT Labor Med 1995;18:330–332.
26.
International Council for the Control of Iodine Deficiency Disorder: Indicator for assessing IDD status. IDD Newslett 1999;15:33–39.
27.
International Council for the Control of Iodine Deficiency Disorder: Standardization of ultrasound and urinary iodine determination for assessing iodine status. IDD Newslett 2000;16:19–23.
28.
Zöllner H, Als C, Gerber H, Hampel R, Kirsch G, Kramer A: Screening for iodine deficiency-iodide concentration or creatinine quotient in random urine. GIT Lab J 2001;3:138–139.
29.
WHO, UNICEF, ICCIDD: Progress towards the elimination of iodine deficiency disorders (IDD). WHO Doc WHO/NHD/99.4. Geneva, WHO, 1999.
30.
WHO, UNICEF, ICCIDD: Assessment of the iodine deficiency disorders and monitoring their elimination. WHO Doc WHO/NHD/01.1. Geneva, WHO, 2001.
31.
Delange F, de Benoist B, Bürgi H, ICCIDD Working Group: Determining median urinary iodine concentration that indicates adequate iodine intake at population level. Bull WHO 2002;80:633–636.
32.
Schicha H, Facorro U, Schürnbrand P, Schreivogel I, Emrich D: Frequency of iodine contamination in a thyroid clinic. Mol Med 1980;4:177–181.
33.
Böckers M, Klee W, Bräuninger W, Bork K: Das Hyperthyreoserisiko durch Lokaltherapie mit PVP-Iod. Akt Dermatol 1986;12:155–157.
34.
Reinwein D, Benker G, König MP, Pinchera A, Schatz H, Schleusener H: Clinical aspects of hyperthyroidism in areas with different iodine supply. Schweiz Med Wochenschr 1987;117:1245–1255.
35.
Grasso L, Maxia PL, Bartalena L, Murtas ML, Taberlet A, Martino E: Iodine contamination in subjects admitted to a general hospital. J Endocrinol Invest 1992;15:307–308.
36.
Gutekunst R, Magiera U, Teichert HM: Iodine deficiency in Germany. Med Klin 1993;88:525–528.
37.
Scriba PC, Gärtner R: Risiken der Jodprophylaxe? Dtsch Med Wochenschr 2000;125:671–675.
38.
Richter R, Below H, Kadow I, Kramer A, Müller C, Fusch C: Effect of topical 1.25% PVP-iodine eyedrops used for prophylaxis of ophthalmia neonatorum on renal iodine excretion and TSH level. Pediatrics, in press.
© 2006 S. Karger AG, Basel
2006
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.