Abstract
Purpose :
A retrospective single-center, comparative cohort study to evaluate the incidence of endophthalmitis following intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents in eyes prepared with topical 5% povidone-iodine (PI) or 0.05% aqueous chlorhexidine (CHX) as antisepsis.
Methods :
For all patients receiving intravitreal anti-VEGF injections at Austin Retina Associates between March 1, 2015 and November 1, 2023, all injections and cases of suspected endophthalmitis were identified with billing codes and confirmed with review of electronic medical record data. Presumed cases of endophthalmitis were considered eyes that presented following injection with pain and/or decreased vision warranting treatment with intravitreal antibiotics. Eyes were grouped based on pretreatment with PI or CHX. Primary outcomes were incidence of endophthalmitis and visual acuity 3 months following infection.
Results :
A total of 290,082 intravitreal injections were administered during the study period. Within the PI group, 64 cases of presumed endophthalmitis occurred following 261,030 injections (0.0245%; 1 in 4,079 injections) compared to 5 cases following 29,052 injections (0.0172%; 1 in 5,810 injections) in the CHX group, a difference that was not significant (p=0.44). For the PI group, there were 11 culture-positive endophthalmitis cases (0.00418%, 1 in 23,935), compared to 0 cases in the CHX group (0%, 0 in 29,060). At 3-months post-infection, average visual acuity in the PI group was 0.95 logMAR (approximately 20/200 Snellen equivalent) compared to 1.42 logMAR (~20/400) in the CHX group (p=0.28).
Conclusions :
The incidence of endophthalmitis following intravitreal injection is low with no difference in the rates of infection with eyes prepared with topical PI compared to CHX. Topical CHX is a safe and effective antiseptic alternative to PI for the prevention of endophthalmitis following intravitreal injection.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.