Visual Loss after Povidone–Iodine Pleurodesis

Abstract

Our observations suggest that high concentrations of iodate in certain povidone–iodine formulations can cause postoperative visual loss, a severe complication, when used in an off-label but widely applied manner during povidone–iodine pleurodesis. We report three cases of bilateral severe loss of vision (ranging from 20/800 vision to the perception of hand motions only) after thoracoscopic surgery involving resection of parts of one lung and instillation of 200 to 500 ml of Jodobac, a 10% povidone–iodine solution, into the thoracic cavity for disinfection and to cause scarring of the pleura for prophylaxis against pneumothorax. (For clinical details of each case, see the Supplementary Appendix, available with the full text of this letter at www.nejm.org.) Ophthalmologic examination and fluorescein angiography revealed, in the first days after surgery, a breakdown of the diffusion barrier of the retinal pigment epithelium ( Figure 1A ). During the next 2 months of follow-up, a granular pattern and atrophy developed in the retinal pigment epithelium ( Figure 1B ).