Chlorhexidine Versus Povidone-Iodine for Intravitreal Injection Antisepsis: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
PURPOSE: While povidone-iodine (PI) is a commonly used antiseptic solution for postinjection endophthalmitis (PIE) prophylaxis, chlorhexidine (CHX) may be better tolerated by patients. This systematic review and meta-analysis aims to comprehensively compare the efficacy and safety of CHX and PI for PIE prophylaxis. DESIGN: Systematic Review and Meta-Analysis. METHODS: MEDLINE, Embase, and the Cochrane Library were systematically searched for relevant literature from January 2000 to July 2024. Studies that compared CHX with PI for either PIE prophylaxis, functional outcomes, or safety outcomes were included. A random-effects meta-analysis was performed, using the Mantel-Haenszel method for dichotomous outcomes and inverse variance method for continuous outcomes. The primary outcomes were the comparative PIE incidence after CHX versus PI. Secondary outcomes pertained to best-corrected visual acuity (BCVA), patient intolerance, pain, safety endpoints, and specimens cultured. RESULTS: = 18/24, 75.0%; OR = 0.15, 95% CI = [0.04, 0.54], P = .004); however, the odds were nonsignificantly different for Staphylococcus aureus (P = .64), Streptococcus viridans (P = .46), Streptococcus mitis (P = .83), and Enterococcus faecalis (P = .46). In cases of endophthalmitis, the mean BCVA was nonsignificantly different between CHX and PI groups at the last study observation (P = .67). The systematic review revealed minimal patient intolerance to CHX, more favorable reductions in pain with CHX than PI, greater corneal epitheliopathy with PI than CHX, and nonsignificantly different reductions in ocular surface microbial isolates between comparators. CONCLUSIONS: CHX and PI were associated with nonsignificantly different rates of presumed, culture-positive, and culture-negative PIE. Endophthalmitis cases associated with both antiseptic agents had a comparable prognosis with respect to BCVA. However, CHX exhibited a more favorable safety and pain profile compared to PI and was associated with a lower odds of positive S. epidermidis cultures in endophthalmitis cases.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.025 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.021 | 0.038 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".