Stewart Michael W
Department of Ophthalmology, Mayo School of Medicine, 4500 San Pablo Rd., Jacksonville, FL, 32224, USA.
Ophthalmol Ther. 2022 Jun;11(3):931-938. doi: 10.1007/s40123-022-00502-1. Epub 2022 Apr 24.
Ophthalmologists frequently face patients who refuse asepsis protocols involving povidone-iodine (PI) due to claims of an allergy to iodine. Such patients usually base this claim on previous reactions to shellfish consumption or to imaging procedures that used iodine-based contrast agents. Allergy to iodine, however, is biologically impossible, and iodine deficiency causes severe developmental problems, including mental retardation. Furthermore, shellfish allergy is due to tropomyosins in muscle tissue, and reactions to intravascular contrast dyes are due to hyperosmolar solutions; neither "allergy" is due to iodine. PI, which contains 9-12% iodine, is the preferred antiseptic for ophthalmic procedures. Experience shows that PI can be administered safely to patients claiming iodine allergy. True allergy to PI is rare and, if indicated, skin patch testing can be performed prior to surgery. Patients who react adversely to highly concentrated (5-10%) PI usually experience toxicity to the corneal and conjunctival epithelium after topical administration. Dilute (0.1-0.25%) PI kills microbes quicker than higher concentrations but for shorter periods of time because the total dose of iodine is smaller. Repeated administration (every 20-30 s) of dilute PI effectively kills microbes for as long as necessary with little risk of epithelial toxicity.
眼科医生经常会遇到一些患者，他们声称对碘过敏，因而拒绝接受涉及聚维酮碘（PI）的无菌操作规范。这类患者通常是基于之前食用贝类或接受使用碘造影剂的成像检查时出现的反应，提出对碘过敏的说法。然而，从生物学角度来看，对碘过敏是不可能的，而且碘缺乏会导致严重的发育问题，包括智力迟钝。此外，贝类过敏是由于肌肉组织中的原肌球蛋白，对血管内造影剂的反应是由于高渗溶液；这两种“过敏”都不是由碘引起的。含9%至12%碘的聚维酮碘是眼科手术的首选防腐剂。经验表明，聚维酮碘可以安全地用于声称对碘过敏的患者。对聚维酮碘真正过敏的情况很少见，如果有必要，可以在手术前进行皮肤斑贴试验。对高浓度（5%至10%）聚维酮碘有不良反应的患者，局部用药后通常会出现角膜和结膜上皮毒性。稀释（0.1%至0.25%）的聚维酮碘比高浓度的聚维酮碘杀菌速度更快，但持续时间较短，因为碘的总剂量较小。反复（每20至30秒）使用稀释的聚维酮碘可以在必要时长有效地杀死微生物，且上皮毒性风险很小。
