Adjunct 0.025% Povidone-Iodine Irrigation at Time of Vitrectomy for Management of Infectious Endophthalmitis: A Multicenter Single-Intervention Study

Purpose: To determine whether adjunctive 0.025% povidone-iodine irrigation during pars plana vitrectomy might improve ocular morbidity in infectious endophthalmitis compared to standard irrigation. Methods: Multicenter, retrospective, comparative cohort study (2019-2024) at four tertiary referral centers. 63 eyes from 63 patients with presumed infectious endophthalmitis requiring vitrectomy were included. Povidone-iodine group (n=32) received 0.025% povidone-iodine in balanced salt solution; control group (n=31) received standard irrigation. Primary outcome was visual acuity at 3 and 6 months. Secondary outcomes included reoperation rates and adverse events. Results: Groups were similar in age, presenting visual acuity (20/2890 vs 20/4000), and culture positivity (13/32 [40.6%] vs 13/31 [41.9%]). Povidone-iodine group was associated with better median visual acuity at 3 months (20/138 [0.84 logMAR] vs 20/3000 [2.21 logMAR], P=.017) and 6 months (20/60 [0.48 logMAR] vs 20/400 [1.34 logMAR], p=.010). Vision improved in 96.7% (29/30) vs 48.3% (14/29) at 6 months (p<0.001). Clinically meaningful improvement of at least 0.3 logMAR occurred in 80.0% of PI-treated eyes (24/30) and 41.4% of control eyes (12/29; p=.003). Reoperation rates were statistically similar, but slightly increased in the povidone-iodine group (28.1% vs 16.1%, p=.365). No ocular toxicity was attributed to povidone-iodine. Conclusion: Adjunctive 0.025% povidone-iodine irrigation during vitrectomy was associated with significantly improved visual outcomes without observed ocular toxicity. This simple, cost-effective intervention may benefit endophthalmitis management, though etiologic imbalances between groups limit attribution of this benefit to PI irrigation alone.