Effective Concentration of Betadine

We totally agree with Drs. Nichamin and O'Brien1 that prophylactic povidone-iodine (Betadine®) before and after surgery is an excellent procedure. However, we have noted that Betadine in the concentration we formerly used has aggravated pre-existing symptoms of conjunctival irritation and keratitis sicca. Therefore, we reduced the concentration to Betadine 0.5% applied before and after surgery. Studies have shown that this concentration is equally effective, and it does not affect the goblet cells of the conjunctiva as occurs with higher concentrations. Betadine is an excellent medicine, and I think we can reduce the time of application as well as the concentration and still protect against the most serious problem, endophthalmitis. Unfortunately, short-term prospective studies are not feasible. However, our clinical experience with Betadine certainly has confirmed what Drs. Masket, Nichamin, and O'Brien have shown, and we have seen as much efficacy with a weaker solution with less conjunctival symptomology and fewer postoperative symptoms such as dryness and irritation. James P.