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Abdhish R. Bhavsar, Geoffrey G. Emerson, M. Vaughn Emerson, Jacob Jones; Endophthalmitis Risk in 11,673 Intravitreous Injections Without Topical Antibiotic Prophylaxis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5611.
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To assess the endophthalmitis risk and results of a consecutive series of 11,673 intravitreous injections without topical antibiotic prophylaxis.
The data from 11,673 consecutive intravitreous injections performed by a single surgeon, including demographics, diagnosis, medication given and safety outcomes including endophthalmitis were retrospectively analyzed. All injections were given with topical proparacaine and tetracaine, topical povidone iodine conjunctival prep (pre- and post-injection), a sterile eyelid speculum and clean non-sterile gloves, but without any topical antibiotics prior to, during or after the intravitreous injections.
2,601 patients were treated with 11,673 intravitreous injections. 1,644 patients were female and 957 were male. The mean age of the patients was 79 years. 9,016 injections of bevacizumab, 1,265 injections of ranibizumab, 974 injections of triamcinolone acetonide, 370 injections of pegaptanib sodium, 33 injections of the dexamethasone implant, 10 injections of ganciclovir and 5 injections of triesence were administered. All injections were administered with pre- and post-injection topical povidone iodine on the conjunctival surface but without topical antibiotics prior to, on the day of or after the injection. The largest number of injections was performed for exudative age-related macular degeneration. Less common causes included diabetic macular edema and cystoid macular edema due to retinal vein occlusions and other diseases. There was one case of endophthalmitis. There were 3 cases of retinal detachment. Secondary uveitis developed in 39 eyes. Steroid responder glaucoma occurred in 65 eyes after triamcinolone acetonide injection. Secondary glaucoma developed in 1 eye after bevacizumab injection. 11,673 consecutive intravitreous injections of bevacizumab, ranibizumab, triamcinolone , dexamethasone implant, ganciclovir, triesence and pegaptanib sodium were given by a single surgeon with one case of endophthalmitis. Of note, the patient who developed endophthalmitis had worn an extended-wear contact lens immediately after the intravitreous injection which may have contributed to the development of endophthalmitis.
Intravitreous injections may be administered safely and with a very low risk of endophthalmitis with topical povidone iodine conjunctival prep but without topical antibiotic prophylaxis.
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