Effect of Double Povidone-Iodine Wash on Rate of Positive Donor Corneoscleral Rim Cultures: A 7-Year Eye Bank Analysis

Introduction: Starting October 2018, the Eye Bank Association of America modified the national standard protocol to incorporate a double povidone-iodine (P-I) wash at the time of procurement. Purpose: To determine if double P-I wash resulted in a reduced rate of positive donor rim cultures. Methods: A comprehensive database review was performed on consecutive corneoscleral tissue handled by The Eye-Bank for Sight Restoration (New York, NY) from January 2015 to December 2021. The primary outcome was the rate of positive corneoscleral rim cultures for bacteria or fungus. Secondary outcomes included rate of postoperative infection (eg, keratitis or endophthalmitis). For analysis, statistical significance was determined as P < 0.05. Results: Of 6079 corneal transplants performed, 3491 were done before implementation of double P-I wash with a total culture positive rate of 0.43%. There were 2588 corneal transplants performed after implementation of double P-I wash with a total positive culture rate of 0.23%, which is a significant reduction (Poisson regression incidence rate ratio [IRR] 0.35 [95% CI 0.089–0.61], P = 0.007). The most common organisms preimplementation were Candida species (46.7% of culture-positive rims), whereas no candida species were isolated postimplementation (logit regression, P = 0.034). Cutibacterium acnes culture positivity rate increased postimplementation to 50.0% versus 13.3% preimplementation (logit regression, P = 0.116). The rate of postoperative infection was 1.55% and 1.00% for preimplementation and postimplementation, respectively (IRR 0.30 [95% CI, 0.18–0.50], P < 0.001). Conclusions: The use of double P-I wash was associated with a decrease in the rate of positive corneoscleral donor rim cultures and a decrease in the rate of postoperative infection.