Povidone-iodine pleurodesis may cause vision loss

Using high concentrations of iodate in povidone-iodine formulations during pleurodesis can cause postoperative vision loss, according to researchers in Germany.

Lars Wagenfeld, MD, and colleagues at University Medical Center Eppendorf performed three thoracoscopic surgeries that involved resecting parts of one lung and instilling 200 mL to 500 mL of Jodobac, a 10% povidone-iodine solution. The solution was used to disinfect patients' thoracic cavities and to cause pleural scarring to protect against pneumothorax, according to the report, published as a letter to the editor in the Sept. 20 issue of The New England Journal of Medicine.

At 1 to 2 days postop, each patient experienced visual disturbances. Specifically, the first patient experienced ocular pain and a central scotoma, the second patient experienced foggy vision and the third experienced flickering vision. Visual acuity also decreased and ranged from 20/800 to hand motions in all three patients, the authors reported.

In addition, all three cases had a breakdown of the retinal pigment epithelium diffusion barrier on the first day postop. However, examinations revealed no anterior segment irregularities and either limited or no fundus changes, they noted.

Over the next 2 months, granular patterns and atrophy developed in patients' retinal pigment epithelia. A paracentral scotoma and a ring scotoma also persisted in the first and third patients.

At 2 months follow-up, visual acuity in the first and third patients stabilized between 20/25 and 20/20, while the second patient recovered to only 20/400 in both eyes, according to the report.