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Sarah Schimansky, Irene Mary Stratton, Emily Fletcher, Quresh Mohamed; Post-injection endophthalmitis rates with reduced povidone-iodine prophylaxis in patients with self-reported iodine allergy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):87.
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To assess the effect of a reduced iodine protocol for patients with self-reported povidone-iodine (PI) sensitivity on the rate of endophthalmitis after intravitreal injections.
Retrospective observational study of all intravitreal injections administered across two hospital sites between January and October 2018. Demographic patient details, PI sensitivities and all cases of suspected and confirmed endophthalmitis were recorded. We identified all patients with self-reported PI sensitivity that had opted to receive either no preoperative PI or reduced iodine protocol (one drop of 5% PI 3 minutes preoperatively followed by washout with normal saline post-injection).
During the study period 2,642 eyes from 2,187 patients received a total of 10,825 intravitreal injections. 550 intravitreal injections (5.08%) were administered to 73 patients (103 eyes) with no or reduced iodine protocol.4 cases of post-injection endophthalmitis were recorded resulting in an overall incidence of 0.04% (1 in 2,500 injections). 3 of these cases occurring in patients treated with no or reduced preoperative iodine protocol leading to an incidence of 0.5% (1 in 200 injections).The mean time from the last intravitreal injection to the onset of symptoms was 3.75 ± 0.96 days. Patients had received a mean of 19.0 ± 7.53 intravitreal injections prior to the development of endophthalmitis. Vitreous biopsies were taken in all cases. Staph. epidermidis was isolated in two cases and no growth was obtained from the remaining two samples. Two patients underwent pars plana vitrectromy.
This is the first large UK study to examine the impact of self-reported PI sensitivity on post-injection endophthalmitis. Our data suggests that reduced PI prophylaxis confers a greater risk of sight-threatening endophthalmitis which patients with PI sensitivity should be aware of. Based on our results alternatives such as aqueous chlorhexidine should be offered in this cohort.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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