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G. Javey, N. Kapoor, P. J. Rosenfeld; Elimination of Post-Injection Topical Antibiotics After Intravitreal Injections. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5016.
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To determine the incidence of endophthalmitis in a population of patients undergoing intravitreal injections in the absence of post-injection daily topical antibiotics.
The retrospective study protocol was approved by the Institutional Review Board (IRB) of University of Miami. Medical chart reviews were performed of all intravitreal injections performed by one physician (PJR) who stopped the use of daily post-injection topical antibiotics following intravitreal injections from April 1, 2008 to Sept 30, 2008. A standard protocol was used for 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. Five percent povidone iodine 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. Patients did not receive any additional topical antibiotics.
During the review interval, a total of 1349 injections were performed (731 ranibizumab, and 618 bevacizumab). The clinical indications for injections included neovascular age related macular degeneration, choroidal neovascularization from other causes, retinal vein occlusion, proliferative diabetic retinopathy, diabetic macular edema, cystoid macular edema, and neovascular glaucoma. Post-injection follow-up ranged between 4 to 28 weeks. No cases of endophthalmitis were identified.
The absence of daily post-injection topical antibiotics did not result in any cases of endophthalmitis. A larger cohort of injections is needed to confirm these results, but it seems as though topical betadine is far more important than post-injection antibiotics in preventing 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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