Risk of Endophthalmitis After Intravitreal Drug Injection When Topical Antibiotics Are Not Required

Abstract

To report the incidence of endophthalmitis after intravitreal drug injection by means of a standardized procedure that does not require topical antibiotics, sterile gloves, or a sterile drape.Methods: Intravitreal injections of preservative-free triamcinolone acetonide or ranibizumab were administered in 2 prospective randomized clinical trials performed by the Diabetic Retinopathy Clinical Research Network. The standardized procedure for these trials requires the use of a topical combination product of povidone-iodine, a sterile lid speculum, and topical anesthetic, but does not require the use of topical antibiotics before, on the day of, or after injection.Results: As of February 23, 2009, a total of 3226 intravitreal injections of ranibizumab and 612 injections of preservative-free triamcinolone had been administered. Topical antibiotics were given on the day of injection in 361 (9.4%) of the 3838 cases, for several days after in-

Impact of Antibiotic Prophylaxis on the Conjunctival Flora of Patients Receiving Intravitreal Antivascular Endothelial Growth Factor Injections

“…Recent studies found that these are not an advantage in terms of reducing the rate of endophthalmitis [8,9]. However, since there is a rationale for their use (eliminating the bacterial conjunctival flora and reducing the pathogenicity of the surviving bacteria) [14,15], it is not surprising that according to the Green-Simms study [16], around 2/3 of the retinal specialists use them for IVT endophthalmitis prophylaxis.…”

“…Halachmi-Eyal et al [6] concluded that endophthalmitis prophylaxis with preinjection of antibiotics does not reduce the endophthalmic rate, nor does it decrease the bacterial count any more than the use of PVI alone [7]. According to Bhavsar et al [8,9], the benefit of preinjection of topical antibiotics is not demonstrated. Besides, increased bacterial resistance to preinjection of antibiotics, particularly in the context of monthly repeated injections, has been described [2].…”

Evaluation of the Incidence of Endophthalmitis after Intravitreal Injection of Anti-Vascular Endothelial Growth Factor

“…To minimize the risk of postinjection endophthalmitis, numerous guidelines, as evidenced by the studies reviewed, have been published [26,27,28]. Regarding prophylactic measures that can be taken during intravitreal injections, use of topical povidone-iodine and a sterile lid speculum could be considered to achieve a reduced rate of endophthalmitis [27].…”

“…Regarding prophylactic measures that can be taken during intravitreal injections, use of topical povidone-iodine and a sterile lid speculum could be considered to achieve a reduced rate of endophthalmitis [27]. Use of povidone-iodine has been reported to be associated with a reduced number of colonies in culture and a confirmed reduction in the risk of postinjection infections [28].…”

“…On the other hand, use of the lid speculum is recommended to avoid needle contact with the lids and lashes at all times [29]. Furthermore, it has been reported that antibiotic use may possibly minimize the risk of injection-related endophthalmitis [26], although another report has indicated that inclusion of the use of topical antibiotics in the injection protocol may not be necessary [27]. However, postinjection infectious endophthalmitis in this study developed despite the use of povidone-iodine, a lid speculum, and pre- and postinjection topical antibiotics.…”