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Hussein Wafapoor, Alexander M. Eaton, Sabrina Prabakaran, Samantha Prabakaran; The Risk Of Single-dose Topical Anesthesia Bottle/Tube Contamination Prior To Intravitreal Injection. Invest. Ophthalmol. Vis. Sci. 2011;52(14):131.
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To evaluate the safety of using single unit dose topical anesthetic eye drops versus single use Lidocaine gel prior to intravitreal injection.
The contents from 60 consecutive bottles of Tetracaine Hydrochloride Ophthalmic Solution 0.5% Viscous Sterile Solution were cultured after use for topical anesthesia prior to intravitreal injections. Next, the contents from 52 consecutive tubes of Lidocaine Hydrochloride gel, USP 2% were cultured after using these in patients for topical anesthesia prior to intravitreal injections. The length of time the tube/bottle was open, and the number of patients anaesthetized, was evaluated.
No growth was found in any of the 60 bottles of the Tetracaine drops; however, 7 of the Lidocaine gel tubes were culture-positive; six for coagulase negative staphylococci and one for Klebsiella oxytoca. None of the patients with the culture positive tubes developed endophthalmitis. The drops were open 1-19 days, and 386 patients were anaesthetized. The Lidocaine gel was open 1-44 days, and 209 patients were anaesthetized.
The use of preservative-free 2% Lidocaine gel may increase the risk of endophthalmitis following intravitreal injection as a result of anesthetic contamination, whereas the use of preserved single unit dose topical tetracaine anesthetic drops in multiple patients did not result in infectious contamination of the drops.
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