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Gisela Velez; Chlorhexidine gluconate antisepsis for intravitreal injection. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4179.
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<br /> Providone-iodine solution has been successfully used as an antiseptic during intravitreal injections of anti-VEGF agents and others. Although rare, sensitivity even at very low concentrations can be a serious issue for a select group of patients. Alternative agents for antisepsis in these patients are often necessary.
We performed a retrospective review of all patients treated with intravitreal injections in our practice over the course of 24 months. Five patients were identified with severe sensitivity to providone-iodine which required use of an alternative antiseptic agent for intravitreal injection. Chlorhexidine gluconate at a concentration of 0.2 % was used for antisepsis.
Five patients (6 eyes) received a total of 82 injections over the course of 24 months, ranging from 27 to 3 injections, with an average of 14 injections per eye. Patients received either bevacizumab or aflibercept injections for the treatment of wet age-related macular degeneration. All patients were treated with chlorhexidine gluconate 0.2%, prepared by diluting a 4% solution with BSS, at the time of intravitreal injection. Close examination revealed no conjunctival irritation or corneal epithelial toxitiy. None of the patients reported irritation or pain immediately or within 24 hours after injection. There have been no cases of endophthalmitis thus far.
Diluted concentrations of chlorhexidine gluconate as low as 0.02% have been shown to be antiseptic. Solutions of up to 1% concentration have been shown to be safe in clinical studies, and have been considered as an alternative agent for the treatment of bacterial keratitis in patients with sensitivities to antibiotics. In our study, use of diluted chlorhexidine gluconate was effective and safe, and should therefore be considered as an alteranative antiseptic agent during intravitreal injections.
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