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Br J Ophthalmol 2004;88:1487-1492 doi:10.1136/bjo.2004.044412
  • World view

A randomised trial of povidone-iodine to reduce visual impairment from corneal ulcers in rural Nepal

  1. J Katz1,3,
  2. S K Khatry2,
  3. M D Thapa2,
  4. O D Schein3,
  5. E Kimbrough Pradhan4,
  6. S C LeClerq1,
  7. K P West , Jr1
  1. 1Division of Disease Prevention and Control, and the Center for Human Nutrition (CHN), Sight and Life Research Institute, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  2. 2Nepal National Society for Comprehensive Eye Care, Kathmandu, Nepal
  3. 3Wilmer Eye Institute and the Dana Center for Preventive Ophthalmology, Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
  4. 4Department of Epidemiology, University of Maryland, Baltimore, MD, USA
  1. Correspondence to: Dr Joanne Katz 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; jkatzjhsph.edu
  • Accepted 2 May 2004

Abstract

Aim: 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.

Footnotes

  • Series editors: W V Good and S Ruit

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