Comparison of the efficacy of povidone-iodine 1.0%, 5.0%, and 10.0% irrigation combined with topical levofloxacin 0.3% as preoperative prophylaxis in cataract surgery

J Cataract Refract Surg. 2013 Jul;39(7):994-1001. doi: 10.1016/j.jcrs.2013.02.039. Epub 2013 May 13.


Purpose: To compare the efficacy of povidone-iodine 1.0%, 5.0%, and 10.0% in combination with topical levofloxacin 0.3% in reducing the preoperative conjunctival bacterial load before cataract surgery.

Setting: Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.

Design: Randomized clinical trial.

Methods: This study enrolled patients scheduled for cataract surgery between July 2010 and January 2011. All patients received topical levofloxacin 0.3% 4 times on the preoperative day and were randomly assigned to these study groups: Group 1 (povidone-iodine 1.0%), Group 2 (povidone-iodine 5.0%), and Group 3 (povidone-iodine 10.0%). In all groups, the conjunctiva was flush irrigated with 10 mL of povidone-iodine of the respective concentration. Conjunctival specimens were obtained at 4 timepoints: baseline (no-surgery eye), before povidone-iodine irrigation, after povidone-iodine irrigation, and at the end of surgery. All specimens were inoculated onto blood and chocolate agars and into thioglycolate broth.

Results: The study was completed by 271 patients. In the control smear (no-surgery eye), no significant difference in positive cultures was found. After 10 mL povidone-iodine irrigation, a considerable reduction in the conjunctival bacterial load occurred in all groups. The difference in positive cultures was statistically significant between Group 1 and Group 3 (P=.024) and between Group 2 and Group 3 (P=.029). Coagulase-negative Staphylococcus was the most commonly isolated bacteria in all groups.

Conclusion: Povidone-iodine 10.0% was more effective than povidone-iodine 1.0% and 5.0% in decreasing the conjunctival bacterial load before surgery.

Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Topical
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Anti-Infective Agents, Local / therapeutic use*
  • Antibiotic Prophylaxis*
  • Bacteria / isolation & purification
  • Bacterial Load
  • Bacteriological Techniques
  • Cataract Extraction*
  • Conjunctiva / microbiology
  • Drug Therapy, Combination
  • Endophthalmitis / prevention & control
  • Female
  • Humans
  • Levofloxacin / therapeutic use*
  • Male
  • Povidone-Iodine / therapeutic use*
  • Prospective Studies
  • Therapeutic Irrigation
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Anti-Infective Agents, Local
  • Levofloxacin
  • Povidone-Iodine