The role of antiseptic prophylaxis before intravitreal injections: a novel ocular spray containing Biosecur citrus extract for the reduction of preoperative microbial load

Abstract

Purpose : The adoption of antiseptic prophylactic strategies is important for patients receiving IVTs to prevent endophthalmitis onset, by avoiding the administration of antibiotics and their associated risk of antimicrobial resistance. The aim of this study was to evaluate the antimicrobial activity of a novel ocular spray containing Biosecur citrus extract (Oftasecur®, Off Health, Florence, Italy).

Methods : This study had a prospective and cross-sectional design. Patients undergoing IVTs were included and trained to administer Oftasecur spray into the treatment eye 4 times a day starting 4 days before the IVT procedure. The sound eye not undergoing IVT procedure was adopted as control. At baseline, a conjunctival swab for microbiological analysis was done in both eyes before the 4-day Oftasecur treatment regimen and at the time of IVT. All the patients were administered a Brief Ocular Discomfort Inventory (BODI) questionnaire, based on a 11-point scale (0 for no discomfort and 10 for maximum discomfort).

Results : In this study 30 patients were enrolled, including 15 males and 15 females (average age 64.7 ± 11.6 [standard deviation, SD] years). At baseline, 53.3% of the total eyes resulted positive after the microbiological analysis of the conjunctival swabs. After the completation of the treatment cycle, only 20% of the eyes were positive at the time of the IVT, referring a significant decrease in the microbial load (p < 0.01). In the treatment group, there was a significant reduction in the positive swabs’ percentages between baseline and the completation of the Oftasecur ocular spray treatment cycle (decreasing from 70.4% to 29.6%; p = 0.003, McNemar's test). Overall, Oftasecur ocular spray resulted safe and well tolerated, showing a mean BODI score of 1.2 (± 0.70 SD).

Conclusions : Prophylactic treatment with Oftasecur ocular spray is associated with a significant reduction in the microbial load in those patients undergoing IVTs. Thus, Oftasecur ocular spray may display a role in the reduction of the risk of IVTs-related endophthalmitis without the need of using antibiotics.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Different isolated bacterial species at baseline and after the completation of Oftasecur prophylaxis in treated and control eyes.