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Rumya R. Rao, Golnaz Javey, Philip J. Rosenfeld, William J. Feuer; Elimination of Post-Injection Topical Antibiotics after Intravitreal Injections. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5608.
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To determine the incidence of endophthalmitis in a population of patients undergoing intravitreal injections in the absence of pre- and post-injection daily topical antibiotics.
The incidence of endophthalmitis was assessed following intravitreal injections performed by one physician (PJR), who stopped the use of daily post-injection topical antibiotics following intravitreal injections on April 1, 2008. A standard protocol was used for all injections. Topical proparacaine was applied followed by a povidone-iodine (10%) scrub of the lids and lashes. A sterile lid speculum was placed, and povidone-iodine (5%) drops were applied over the ocular surface three times several minutes apart. Between povidone-iodine drops, a sterile cotton swab soaked in sterile 4% lidocaine was applied to the area designated for injection in the infero-temporal quadrant. Povidone-iodine 5% solution was applied to the site just prior to injection. Immediately after the injection, one drop of topical 0.5% moxifloxacin (Vigamox, Alcon Pharmaceuticals, Fort Worth, Texas) was placed into the inferior fornix in all patients injected between April 1, 2008 until June 30, 2009. Thereafter, the one drop of antibiotic was replaced with one drop of povidone-iodine 5%. Following the injection, none of the patients received any additional topical antibiotics.
From April 2008 through June 2009, a total of 3928 injections were performed. From July 2009 through October 2010, a total of 4515 injections were performed. Overall, 8443 injections were performed without the use of daily post-injection topical antibiotics. The injected medications included ranibizumab, bevacizumab, and triamcinolone acetonide. The clinical indications for injections included neovascular age-related macular degeneration, choroidal neovascularization from other causes, retinal vein occlusions, proliferative diabetic retinopathy, diabetic macular edema, cystoid macular edema, and neovascular glaucoma. No cases of endophthalmitis were identified. The 95% confidence interval for the true rate of endophthalmitis ranged from 0% to 0.044%.
The absence of daily post-injection topical antibiotics did not result in any cases of endophthalmitis. It seems as though topical povidone-iodine is adequate to prevent endophthalmitis, and the use of topical antibiotics may not be justified based on their cost and the growing epidemic of antibiotic resistant organisms.
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