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Amber Hoang, Keegan Harkins, Maria Manuela Gutierrez Velez, Barlett Hayes II, Margaret Greven, Craig M Greven, Rajiv Shah; Endophthalmitis Rates Following Anti-VEGF Intravitreal Injections with 10% Betadine. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2032. doi: https://doi.org/.
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Development of endophthalmitis is one of the most devastating complications of intravitreal injections leading to loss of vision and the eye. To date, there is no study in the literature to assess the effectiveness of 10% betadine in the prevention of endophthalmitis. We performed a retrospective, observational cohort study to evaluate the rate of endophthalmitis with 10% betadine compared to published rates of endophthalmitis using current standard of care 5% betadine.
A retrospective, observational cohort study review of patients developing post-intravitreal injection endophthalmitis at Wake Forest Baptist Eye Center using 10% betadine. ICD-10 procedure codes for intravitreal injections of “bevacizumab”, “ranibizumab”, “aflibercept” were searched for the time frame January 2001 – November 2018. Of these charts, codes for “endophthalmitis”, “corneal erosion”, and “corneal abrasion” were searched. Cases of endogenous endophthalmitis, uveitis, intraocular steroids, and immunosuppression were excluded. Primary outcome is development of endophthalmitis post-intravitreal injections with 10% betadine. Secondary outcome is development of side effects of corneal toxicity with 10% betadine. Statistical analysis was performed and compared to published rates of endophthalmitis using current standard of care 5% betadine.
A total of 41,314 anti-VEGF intravitreal injections (4,315 patients) in the 10% betadine group were included, from which 2 cases of endophthalmitis were identified. Cultures demonstrated pasteurella multocida and coagulase-negative staphylococci. Current published rates of endophthalmitis after intravitreal injections with 5% betadine range from 0.02% to 0.08%. The rate of post-intravitreal endophthalmitis in the 10% betadine group is 0.0048%, which is statistically significantly lower than in the 5% betadine group (p<0.05, chi-squared test). Corneal toxicity was not evidenced in our study; however, increased patient complaints of irritation post-injection were noted in the chart review.
Our results are consistent with our hypothesis that using 10% betadine may lower rates of post-intravitreal endophthalmitis compared to 5% betadine and should be considered as a reasonable alternative to the current standard of care.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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