Rifabutin-associated with bilateral uveitis in an HIV negative patient

BACKGROUND: Rifabutin-associated uveitis has often been described in patients with HIV. We present the case of a bilateral non-granulomatous uveitis in an HIV negative patient on rifabutin therapy. HISTORY AND SIGNS: A 79-year-old man presented with acute pain and decreased vision in the left eye. He had a 2-months history of Mycobacterium avium pneumonia and was treated with rifabutin, clarithromycin and ethambutol since then. At presentation, the visual acuity was hand movement. On biomicroscopy, the anterior chamber showed inflammatory sings such as hypopyon and early posterior synechiae. Ultrasound revealed no vitreal infiltration. The fellow eye was initially without any pathology. Serological testing and blood cultures were negative. THERAPY AND OUTCOME: The next day, the fellow right eye was also affected showing signs of anterior and posterior uveitis. Following intensive topical steroidal therapy, clinical findings improved within hours. Rifabutin therapy was discontinued. Later on the visual acuity of both eyes improved to 20 / 100. CONCLUSIONS: Bilateral rifabutin-associated uveitis may also occur in an HIV negative patient. A toxic reaction due to concomitant clarithromycin therapy might be causal. Well directed history, intensive topical steroids and the cessation of rifabutin therapy are helpful in the management of such rare uveitis.     

Rifabutin-associated uveitis in an immunosuppressed pediatric patient without acquired immunodeficiency syndrome

Purpose: To describe a case of bilateral, symptomatic rifabutin-associated uveitis with hypopyon and vitreal opacities in an immunosuppressed pediatric patient without acquired immunodeficiency syndrome (AIDS).Method: Case report. An 8-year-old boy presented with bilateral uveitis 24 months after a bilateral lung transplant.Results: Our patient, whose medications included rifabutin, clarithromycin, and immunosuppressive agents, responded to discontinuation of the rifabutin and initiation of intensive topical corticosteroid therapy with complete resolution of the uveitis.Conclusion: Rifabutin-associated uveitis may occur in a non-AIDS pediatric patient.     

Rifabutin-associated hypopyon uveitis in human immunodeficiency virus-negative immunocompetent individuals

OBJECTIVE: To report the occurrence of rifabutin-associated hypopyon uveitis in human immunodeficiency virus (HIV)-negative immunocompetent individuals. DESIGN: Retrospective case series. PARTICIPANTS: Three HIV-negative subjects on rifabutin and clarithromycin for Mycobacterium avium complex infections with hypopyon uveitis are described. One subject was iatrogenically immunosuppressed because of a prior lung transplant. Two subjects had no known immunosuppressive conditions. INTERVENTION: Topical and regional steroid therapy. Discontinuation of rifabutin was required in two subjects. MAIN OUTCOME MEASURES: Visual acuity, resolution of hypopyon, anterior uveitis, and vitreitis. RESULTS: All subjects had resolution of hypopyon after therapy, two within 24 hours of beginning topical steroids. Vitreitis resolved with the discontinuation of rifabutin in two subjects. Chronic low-grade anterior uveitis and vitreitis were observed in the remaining subject, whose rifabutin dose was lowered but not discontinued because of active Mycobacterium avium complex osteomyelitis. CONCLUSIONS: Rifabutin-associated uveitis is well described in HIV-positive individuals, but it has been reported only once in an HIV-negative individual. We report two cases of hypopyon uveitis in immunocompetent individuals and one case in an immunosuppressed HIV-negative individual. All three subjects were receiving concurrent rifabutin and clarithromycin. Awareness that this entity can occur in HIV negative and nonimmunosuppressed individuals and that it can mimic infectious endophthalmitis may spare the subject from an invasive workup of systemic infection.     

Rifabutin induced vitritis in AIDS patients

The authors report three patients with the acquired immunodeficiency syndrome (AIDS) who developed uveitis while prophylactically taking rifabutin (300 mg/kg or more), clarithromycin and fluconazole. The uveitis presented unilaterally, but became bilateral within seven days in each patient. Inflammation was more severe in the vitreous than in the anterior chamber. Examination of the vitreous and blood from one patient with microbiological smears, bacterial and fungal culture and the polymerase chain reaction (PCR) to herpesviruses did not reveal an infectious etiology. Discontinuation or decreasing the dose of rifabutin to 300 mg/day and treatment with topical steroids and cycloplegics resulted in resolution of the uveitis within two weeks. Our findings support the observation that prophylactic doses of rifabutin, combined with clarithromycin, fluconazole or other agents which can increase rifabutin levels, can induce uveitis in patients with AIDS. It is important to recognize that a severe vitritis which can obscure visualization of the retina can be solely attributed to rifabutin in patients with AIDS. Therapy requires lowering the dose of rifabutin and the use of topical corticosteroids and cycloplegics.     

Comparative laser flare measurement and fluorophotometry in anterior and posterior uveitis

Summary Recent studies have sought to quantify aqueous flare by laser flare measurement. An increase in aqueous flare caused by a rise of protein concentration was frequently found both in anterior and posterior segment disease. This has been interpreted as a breakdown of the blood – aqueous barrier (BAB). By measuring the diffusion coefficient of the BAB compared to the aqueous flare value in patients with anterior and posterior uveitis, the extent to which the increase in flare value was related to a possible break down of the BAB was examined. Patients: Thirty-nine normal eyes (23–78 years; 41.6 ± 18.6), 18 eyes with anterior uveitis (iritis, iridocyclitis; 18–57 years; 35.2 ± 12.4) and 29 eyes with posterior uveitis (chorioretinitis or retinochorioiditis; 18–51 years; 31.7 ± 10.5). The diffusion coefficient P(a) of the BAB was measured fluorophotometrically, while the flare value was quantified by laser flare measurement. Results: Flare values (1/ms) were found to be significantly increased (p < 0.001) compared to normal eyes (4.6 ± 1.7) both in anterior uveitis (20.9 ± 8.5) and in posterior uveitis (17.4 ± 8.3) but did not significantly differ between them (p = 0.43). The diffusion coefficient P(a) (10^–3/min) of the BAB was not significantly different (p > 0.05) between normal eyes (0.5 ± 0.2) and eyes with posterior uveitis (0.9 ± 0.7), whereas it was significantly increased (p < 0.001) in anterior uveitis (6.5 ± 5.4) compared to the other groups. Conclusions: (1) In posterior uveitis, an increased flare value is not necessarily correlated with a breakdown of the BAB; proteins may enter the aqueous from posterior. (2) Assessing the function of the BAB in posterior segment disease using laser measurement should be carried out with caution; if possible, permeability measurements of the BAB should be undertaken seperately.      

Hypopyon Uveitis Following Band Keratopathy Removal in Ankylosing Spondylitis—A Case Report

Purpose: To report an interesting case of hypopyon uveitis following successive band keratopathy removal in both the eyes in a patient with ankylosing spondylitis. Design: Retrospective case report. Results: A 70-year-old Indian male with ankylosing spondylitis and a 40-year history of chronic anterior uveitis underwent band keratopathy removal (EDTA chelation) in both eyes at an interval of six months. On both occasions, he developed a severe hypopyon uveitis on the first postoperative day, which was successfully treated with topical and oral steroids. Conclusion: Any ocular procedure, even as trivial as band keratopathy removal, can elicit a severe uveitis in a chronically inflamed eye. The probable mechanisms are discussed.     

“High endothelial venules”: expression kinetic in IRBP-induced EAU

Summary Experimental autoimmune uveitis (EAU) is a T-cell-mediated disease expressing high endothelial venules (HEVs) in the retina. HEVs could be responsable for the absorption of activated T-cells. The purpose of this study was to investigate the kinetics of HEV expression in the murine IRBP (interphotoreceptor retinoid binding protein) induced EAU. Methods: B10.A mice were immunized subcutanously with IRBP. The eyes were analysed on days 10, 18, 24 and 28 (n = 5 for each time point). While HEVs were identified with the mAb MECA 325, the control mAb MECA 20 stained all endothelial cells. Results: HEVs were detectable in the intact retina from day 10. Presence of HEVs peaked on day 18 and decreased by day 28, when maximal inflammation and retinal destruction was detectable. Conclusion: HEV expression could play a central role in the onset of EAU, allowing homing and migration of inflammatory cells into the eye.      

Hypopyon Uveitis—A Rare Presentation of Intraocular Tuberculosis

Abstract

Purpose: Intraocular TB is usually known to present as granulomatous uveitis and presence of hypopyon is extremely rare. The authors describe a case of intraocular tuberculosis presenting as hypopyon uveitis.

Design: Case report.

Methods: A 40-year-old immunosuppressed woman presented with acute granulomatous uveitis with hypopyon and cervical lymphadenopathy. She underwent aqueous tap for polymerase chain reaction, lymph node biopsy, and PET scan.

Results: Molecular diagnostic procedures provided a definite diagnosis of ocular tuberculosis. Antitubercular treatment and steroids led to improvement.

Conclusion: Intraocular TB can present as hypopyon uveitis and a high index of suspicion is needed, especially in the endemic areas.     

Epidemiology of toxocariasis – environmental investigations

Summary Due to the large number of differential diagnostic possibilities, the etiology of endogenous uveitis is still hard to determine. One reason for uveitis may be the occurrence of parasites. However, too little attention is paid to this underlying disease. Methods: To identify certain sources of infection, ovoscopic probes of 98 dog feces from the urban area of Halle were taken. The material was collected from children's playgrounds, parks and swimming pools. A retrospective analysis of patient case data from the records of the University Eye Hospital for the years 1986–1995 complemented the environmental and parasitological examination of patients with Toxocara canis and T. cati infections. Results: From the ovoscopic examinations, 16 % of the fecal samples contained T. canis eggs. Seventeen percent contained coccicidal sporocysts. Eggs of Trichuris vulpis and not clearly identifiable nematodal larvae were found in 1 % of the samples. The reasons for the morphology was, in one instance, suspected Echinococcus eggs. The fact that 12 or 15 parasitologically positive dog excrement samples were taken from the immediate vicinity of children's playgrounds and another three directly from these grounds should be regarded as particularly critical. The investigated patient case data records revealed for the period studied nine uveitic patients with T. canis infection. The diagnosis was based on the larva precipitation test in all cases. After correct diagnosis and appropriate treatment, the prognosis was favorable. The specific treatment had to be repeated in two patients. Conclusions: The environmental parasitological study presented proves the relatively high prevalence of pathogenic causal agents in dog excrement samples from the area of urban recreation and leisure grounds, in particular, children's playgrounds. Parasite infestation is a mirror of the efficiency of hygienic and social measures. Public health education must be reinforced. Differential diagnosis of chronic endogenous eye diseases must pay more attention to infections by parasites.      

Topiramate-induced Bilateral Anterior Uveitis Associated with Hypopyon Formation

Purpose: To report a rare case of bilateral anterior uveitis with hypopyon formation following systemic topiramate use.

Materials and Methods: A 40-year-old woman with migraine headache who was under topiramate treatment referred with bilateral ocular pain and visual blurring. Physical examination disclosed shallow anterior chamber and high intraocular pressure in both eyes. Following discontinuation of topiramate a severe bilateral anterior uveitis with posterior synechiae and hypopyon developed.

Results: Ocular inflammation resolved with systemic and topical steroid. Because of severe cataract and synechiae formation she underwent phacoemulsification/posterior chamber intraocular lens implantation and visual acuity of both eyes improved to 20/25.

Conclusion: Topiramate should be added to the list of drugs that may cause anterior uveitis and hypopyon formation.     

利福布汀在获得性免疫缺陷综合征患者中引起的前房积脓型葡萄膜炎

目的 提高对利福布汀相关性前房积脓型葡萄膜炎的认识、诊断及治疗能力。方法 回顾性系列病例研究。回顾分析14例(24眼)获得性免疫缺陷综合征(AIDS)合并结核分枝杆菌复合群(MTC)或非结核分枝杆菌(NTM)感染患者应用利福布汀后发生前房积脓型葡萄膜炎的眼部临床表现及其治疗随访结果。结果本组病例中,男性13例、女性1例;年龄24~78岁,平均(42.50±14.29)岁;体重44~73 kg,平均(54.21±9.07)kg。CD_(4)^(+)T淋巴细胞(19~260)个/μL,平均(91.07±59.36)个/μL。临床表现:单眼或双眼(同时或先后)急性发作眼红、眼痛、畏光、视力明显下降。大量角膜后沉积物,前房纤维素性渗出,前房积脓,虹膜后粘连。眼底无法窥及。B超示玻璃体大量团状强回声影。治疗:14例均给予局部糖皮质激素类药物、扩瞳剂治疗。1例除局部治疗外给予全身应用甲泼尼龙40 mg, 3 d。14例(24眼)患者眼部病变均迅速完全缓解,8眼葡萄膜炎复发。结论 随着利福布汀的广泛应用,利福布汀相关性葡萄膜炎日益增多,医师应重视这种潜在的并发症。认识此病,可以避免前房穿刺、玻璃体注药、玻璃体切除术等有创操作。及时治疗可大大提高患者视力,减少并发症的发生。     

Experimental autoimmune uveoretinitis: characterization of retina infiltrating cells

Summary The chronic model of murine EAU induced by interphotoreceptor retinoid binding protein represents a disease similar to clinical chorioretinitis. In this study we characterized the kinetics of retina infiltrating T-cells, macrophages and expression of the adhesion molecules ICAM-1 and ICAM-2. Methods: B10.A mice were immunized subcutaneously with IRBP, and the eyes were analyzed on days 10, 18, 24 and 28. The infiltrating cells were characterized by mAbs recognizing T-cell receptors (TCR) V?6 and V?8, T-cell markers, macrophages and ICAM-1 and ICAM-2. Results: While CD8 ⁺ T-cells and ICAM-2 were detectable from day 10 (retina is intact) until day 28, CD4 ⁺ T-cells, macrophages and ICAM-1 appear with the onset of retinal destruction. Starting at day 10 the dominating TCR was V?6; V?8 was noticed from day 18 on. Conclusion: CD8 ⁺ T-cells infiltrating the intact retina and stimulating the expression of high endothelial venules (HEVs) could be responsiable for the onset of uveitis.      

Three cases of uveitis induced by mycobacteriosis therapy using rifabutin

BACKGROUND: Rifabutin has been used clinically to combat tuberculosis as well as nontuberculosis Mycobacterium since 2008 in Japan. Uveitis associated with rifabutin is described in many reports, but none of these are of Japanese. We report three Japanese cases of nontuberculosis Mycobacterium with rifabutin-associated uveitis. CASE 1: A 91-year-old woman developed bilateral uveitis with hypopyon and vitreous opacity at 2 months after the initiation of rifabutin administration. The uveitis persisted regardless of topical administration of corticosteroids and the discontinuance of rifabutin. Her right eye required goniosynechiolysis in order to cure a secondary glaucoma, and the left eye required vitrectomy in order to cure vitreous inflammation. CASE 2: A 72-year-old woman developed uveitis in her right eye at 7 months after the initiation of rifabutin administration. Rifabutin was stopped two days after she presented, and the uveitis resolved quickly with topical administration of corticosteroids. CASE 3: An 83-year-old woman developed bilateral uveitis at 6 months after the initiation of rifabutin administration. The rifabutin was stopped two months after the initiation and the uveitis resolved with topical corticosteroids. CONCLUSION: Rifabutin rarely causes uveitis as an ocular side effect. Early diagnosis and is important and reduction or discontinuance of the rifabutin as well as anti-inflammatory therapy need to be implemented when a patient develops this condition.     

Bilateral Hypopyon as the Presenting Feature of Chronic Myeloid Leukemia

Purpose: To report bilateral hypopyon as an unusual presenting feature of chronic myeloid leukemia (CML). Design: Observational case report. Methods: A 68-year-old male presenting with bilateral hypopyon uveitis underwent hematological investigations and cytology of hypopyon. Results: Blood smear revealed increased leucocyte count with presence of abnormal cells (myelocytes, band forms, and promyelocytes) suggestive of CML. Cytopathology of hypopyon revealed predominance of lymphocytes and few plasma cells. CML was confirmed by hematological investigations. Patient was initiated on chemotherapy under the care of an oncologist and is stable. Conclusions: Elderly patients presenting with hypopyon uveitis should be investigated to rule out masquerade syndrome.     

Influence of postoperative topical application of miotics after cataract extraction on intraocular pressure and the blood-aqueous barrier

Background: In the present study we evaluated the influence of topical miotics on intraocular pressure and the blood-aqueous barrier after uncomplicated phacoemulsification and PC-IOL implantation. Patients and methods: Fifty-two eyes were randomized into 2 groups: with miotics (n = 28) and without miotics (n = 24). The IOP was measured before, 6 h, 1 and 2 days after surgery. Measurement of aqueous flare was performed before and on days 1 and 2 after surgery. Patients with glaucoma, PEX or previous intraocular surgery were excluded. Results: In the group without miotics the IOP was 17.9 mm Hg (± 3.34) 6 h postoperatively; in the second group it was 15.5 mm Hg (± 3.25); P = 0.04. On the first postoperative day the IOP measured in the group without miotics was 15.3 mm Hg (± 2.70) and with miotics 13.0 mm Hg (± 2.28); P = 0.007. On the second day in the group without miotics the IOP was 13.9 mm Hg (± 3.05) and with miotics 12.60 mm Hg (± 2.19); P = 0.53. The changes in aqueous flare on the first and second day after surgery showed no significant influence of miotics on the blood-aqueous barrier (P > 0.05). Conclusions: Immediate postoperative application of topical miotics led to a small yet significant reduction of the IOP during the first 24 h after surgery. Our data suggest that there is no need for pharmacological reduction of the IOP after uncomplicated cataract surgery.      

First results of in-vivo visualization of the tear film and structures of the cornea with a modified confocal laser scanning ophthalmoscope

Background: As the slit-lamp technique is an restrictive method for the in-vivo examination and documentation of the multi-layer structure and the dynamics of the tear film and the cornea, e. g. during wound-healing processes, our aim was to find out whether it is possible to change the confocal laser scanning ophthalmoscope (CLSO; Zeiss) into a high-resolution confocal laser scanning microscope (CLSM) for the visualization of the anterior segments of the eye and the tear film by adapting a special objective system. In order to gain information concerning the function of such a cornea microscope we examined selected patients with erosion or pterygium before and after operation and subsequent phototherapeutic keratectomy (PTK), as well as some in-vitro corneal surfaces after photorefractive keratectomy (PRK). Material and methods: We developed an objective adapter for the CLSO in order to focus the laser beam onto anterior segments of the eye to visualize the tear film and the layer structure of the cornea. By combining the long-distance objective or a contact objective with different zoom-optic lenses it was possible to alter the scan field size and so the magnification of the CLSM by a factor of up to 1000. Results: The CLSM provides a new method for the in-vivo examination of the tear film and its dynamics as well as the thin layers of the cornea in real-time imaging technique with high contrast and resolution in non-contact or contact procedures. Conclusion: This system is a unique tool for evaluating and monitoring the effect of excimer laser ablation after PTK and PRK on the corneal surface and the dynamics of the tear film. The application of this method causes no pain for the patient.      

Pseudophakia in children with juvenile arthritis

Background: Cataract secondary to juvenile rheumatoid arthritis is a severe, vision-threatening complication in early childhood. Intraocular lens implantation is controversial. The follow-up of four pseudophakic eyes of three patients and their perioperative therapeutic regimen were retrospectively analyzed. Early and late postoperative complications are reported. Patients and methods: Both girls had lens aspiration and posterior lens implantation at the ages of 6 and 12 years, the boy at the age of 10 and 14 years. All patients had relapsing anterior uveitis. The follow-up time was 3 years (1–6 years). One girl was diagnosed with sarcoidosis, causing juvenile arthritis. Both girls had perioperative methothrexate and prednisolone therapy. The boy had azathioprine therapy at the time of his first cataract surgery; later he had no systemic therapy. Both girls' intraocular lenses were implanted at different eye hospitals. Results: Both girls had severe inflammatory reactions after surgery. At the hospitals both eyes had surgical revision for iris capture. In one case this was combined with exchanging the intraocular lens. Iris capture persisted for this eye and later vitrectomy with silicone oil filling was necessary to delay phthisis, resulting in amaurosis. For two pseudophakic eyes vitrectomy was necessary later because of severe vitreous opacities, but visual acuity was severely diminished by chronic cystoid macular edema and epiretinal membranes. The boy developed in his second eye intermittent iris bombata and persistent secondary glaucoma, visual acuity was stabilized at 0.5. Conclusions: Secondary cataract due to juvenile rheumatoid arthritis or sarcoidosis is a difficult situation for phacoemulsification with intraocular lens implantation in children. For severe inflammatory complications intense local and systemic anti-inflammatory therapy is mandatory. Visual prognosis is reduced for the uveitic posterior segment and glaucoma complications. IOL implantation can be recommended for only a very few patients.      

Comparison of the efficacy of ER-YAG laser sclerostomy ab externo versus trabeculectomy in the treatment of patients with primary open – angle glaucoma

Purpose: This study was conducted to compare the efficacy of the Er-YAG laser sclerostomy ab externo versus trabeculectomy in the treatment of primary open – angle glaucoma. Methods: Twelve patients with POAG underwent ab externo laser sclerostomy using an Er-YAG laser (Sklerostom 2.9?; λ = 2940 nm, t = 200 μs, 2 Hz, 400 μm, 15 mJ). Only local medication was used, and there were no risk factors for failure. As a control group 12 patients out of 248 standardized trabeculectomies were matched in terms of age, sex, diagnosis and local medications. No antimetabolites were used in either group. Results: After a follow-up of 9 months in the sclerostomy group 53 %; (7/12; P = 0.03) showed a patent fistula in comparison of 100 % in the trabeculectomy group. There was a significantly lower mean IOP during the first postsurgical week in the group of sclerostomies (3.6 ± 1.5 mmHg versus 7.5 ± 2.7 mmHg; P = 0.0001) with a higher incidence of choroidal detachments (9/12 versus 2/12; P = 0.004). The choroidal detachments lasted longer in the sclerostomy group (3.5 months versus 0.3 months; P = 0.014). Iris incarcerations were found only in sclerostomies (7/12; P = 0.05). Conclusions: Based on these findings, Er-YAG laser sclerostomy prooved to be less effective than trabeculectomy in the treatment of glaucoma patients. Er-YAG laser sclerostomies were associated with a higher incidence of postsurgical complications such as hypotony, choroidal detachments and iris incarcerations. At this point Er-YAG laser sclerostomy is not superior to conventional trabeculectomy.      

Diode laser thermokeratoplasty – first clinical experience

Purpose: Pulsed holmium lasers are currently used to correct hyperopia by means of laser thermokeratoplasty (LTK). Series of μs laser pulses are applied with a high repetition rate to induce shrinkage of corneal collagen fibers. The pulsed energy application results in intrastromal temperature peaks of up to 200 °C. A continuously emitting laser diode can – as we demonstrated recently in an invivo study on minipigs – be used for LTK and may be of advantage because the temperature rise is more steady. The aim of this study was to examine the safety, amount, and stability of hyperopic correction of diode LTK on blind human eyes. Methods: We used a laserdiode that was set to continuously emit light at λ = 1.854 μm/μ_a = 1.04 mm^–1(group I, n = 4) or 1.87 μm/μ_a = 1.92 mm^–1 (group II, n = 4). Radiation energy was 100 to 150 mW for 10 s per coagulation. Eight coagulations on a single ring (group I) and 16 coagulations on a double ring (group II) diameter were applied in the cornea concentric to the entrance pupil by means of a vacuum-fixed application mask (group I = conjunctival fixation; group II = corneal fixation) and a handpiece with a focusing optic. Preoperatively as well as 1 week, 1, 2, 3, 6 12 and 18 months postoperative ophthalmologic controls were performed and the corneal refractive power was measured. Results: In group I initial refractive changes of up to + 4.9 D were achieved (1 week postoperative). However, due to the great penetration depth of the laser irradiation, large endothelial defects resulted beneath the stromal coagulations. In group II an initial refractive change of up to + 6.8 D was achieved and as a result of the reduced penetration depth, the endothelial cell damage was much reduced. Partial regression of the refractive effect occured in all subjects, which continued in higher refractive changes during the 2^nd postoperative year. The refractive effect at 12 months was + 0.6 to + 1.5 D in group I and + 0.9 to + 5.7 D in group II. At 12 months the induced astigmatism was 0.5 to 2.2 D in group I and 0.3 to 1.6 D in group II. No serious adverse effects were noticed. Conclusion: A continously emitting laser diode working at a wavelength of 1.87 μm can be used to correct hyperopia by means of LTK safely and effectively. Regression occurs predominantly in the first 6 postoperative months. Further studies must be conducted to determine the importance of patient inherent parameters such as age in establishing a nomogram.      

Colonization of the conjunctiva with Propionibacterium acnes before and after application of polyvidone iodine before intraocular surgery

Background: Propionibacterium acnes has been described as a causative agent of postoperative endophthalmitis. This gram-positive, immotile, non-spore-forming bacterium is highly pleomorphic and grows under conditions of low to no oxygen concentration. It is commonly found on the skin at the openings of sebaceous glands and on hairs. A near-symptomless postoperative endophthalmitis occurs particularly when Propionibacteria are enclosed in the capsular bag. We investigated to what extent the number of P. acnes in the conjunctival sac can be reduced by preoperative disinfection with polyvidone iodine (1 %). Patients and methods: A total of 261 patients with intrabulbar surgery had two conjunctival swabs taken: the first immediately prior to preoperative preparation in the operating theatre, following in-patient application of antibiotic eye drops (Polymyxin-B-sulfat, Neomycinsulfat and Gramicidin in combination); the second swab was taken after disinfection with polyvidone iodine before opening the conjunctiva. Results: Of the 261 swabs, 60 (23 %) taken prior to polyvidone iodine application were positive for Propionibacterium acnes. Following polyvidone iodine treatment, a further 5 (1.9 %) remained culture-positive. After disinfection, 55 (92 %) of the 60 positive swabs for Propionibacterium acnes remained culture-negative. Conclusions: We concluded that a significant reduction of P. acnes can be achieved by preoperative application of polyvidone iodine (1 %) (P < 0.001).