Tolerability of 0.5% Liposomal Ozonated Oil Versus 0.6% Povidone-Iodine in Antiseptic Prophylaxis for Intravitreal Injections.

INTRODUCTION

This work compares the tolerability of 0.6% povidone-iodine (PI) and 0.5% liposomal ozonated oil (LOZ) as antiseptic prophylaxis in patients undergoing intravitreal injections (IVI), aiming to optimize preventive strategies against injection-related endophthalmitis.

METHODS

This multicenter cohort study was conducted at the University Paris Est, Créteil, and the University of Trieste between November 2024 and June 2025. A total of 691 patients with maculopathies (329 in the PI group, 362 in the LOZ group) were enrolled. Patients received either 0.6% PI or 0.5% OZ topical prophylaxis three times daily for 3 days before and after IVI. Clinical tolerability was assessed by slit-lamp examination, grading conjunctival hyperemia, discharge, tarsal papillae, corneal changes, burning, and foreign body sensation (0-4 scale). Patient-reported discomfort was evaluated using a Visual Analogue Scale (VAS), classified into four categories: 0-10 mm (score 0), 11-40 mm (score 1), 41-70 mm (score 2), and 71-100 mm (score 3). Statistical analyses included generalized linear models adjusted for dry eye and prostaglandin therapy.

RESULTS

LOZ treatment was associated with significantly lower mean scores for hyperemia (0.52 vs. 1.51), discharge (0.15 vs. 0.91), tarsal papillae (0.02 vs. 0.57), corneal changes (0.04 vs. 0.58), burning (0.25 vs. 1.69), and foreign body sensation (0.21 vs. 1.58) compared to 0.6% PI (all p < 0.001). VAS scores confirmed superior tolerability in the LOZ group (mean 0.23 vs. 1.58). No cases of endophthalmitis occurred in either group.

CONCLUSIONS

LOZ (0.5%) represents an ophthalmic antiseptic that addresses the limitations of traditional povidone-iodine preparations, suggesting it may represent a more patient-friendly prophylactic alternative for IVI.