Risk of endophthalmitis after intravitreal drug injection when topical antibiotics are not required: the diabetic retinopathy clinical research network laser-ranibizumab-triamcinolone clinical trials.

Abstract

OBJECTIVE:

To report the incidence of endophthalmitis after intravitreal drug injection by means of a standardized procedure that does not require topical antibiotics, sterile gloves, or a sterile drape.

METHODS:

Intravitreal injections of preservative-free triamcinolone acetonide or ranibizumab were administered in 2 prospective randomized clinical trials performed by the Diabetic Retinopathy Clinical Research Network. The standardized procedure for these trials requires the use of a topical combination product of povidone-iodine, a sterile lid speculum, and topical anesthetic, but does not require the use of topical antibiotics before, on the day of, or after injection.

RESULTS:

As of February 23, 2009, a total of 3226 intravitreal injections of ranibizumab and 612 injections of preservative-free triamcinolone had been administered. Topical antibiotics were given on the day of injection in 361 (9.4%) of the 3838 cases, for several days after injection in 813 cases (21.2%), on the day of injection and after injection in 1388 cases (36.2%), and neither on the day of injection nor after injection in 1276 cases (33.3%). Three cases of culture-positive endophthalmitis occurred after ranibizumab injections (0.09%), and no cases occurred after triamcinolone injections. In all 3 cases of endophthalmitis, topical antibiotics were given for several days after the injection but not before injection.

CONCLUSIONS:

The results suggest that a low rate of endophthalmitis can be achieved by means of a protocol that includes use of topical povidone-iodine, a sterile lid speculum, and topical anesthetic, but does not require topical antibiotics, sterile gloves, or a sterile drape. Trial Registration clinicaltrials.gov Identifiers: NCT00444600 and NCT00445003.

• Authors: Abdhish R Bhavsar, Joseph M Googe Jr, Cynthia R Stockdale, Neil M Bressler, Alexander J Brucker, Michael J Elman, Adam R Glassman, Diabetic Retinopathy Clinical Research Network
• Journal: Archives of ophthalmology (Chicago, Ill. : 1960) (Arch Ophthalmol) Vol. 127 Issue 12 Pg. 1581-3 (Dec 2009) ISSN: 1538-3601 [Electronic] United States
• PMID: 20008710 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Anesthetics, Local
• Angiogenesis Inhibitors
• Anti-Bacterial Agents
• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Glucocorticoids
• Vascular Endothelial Growth Factor A
• Povidone-Iodine
• Triamcinolone Acetonide
• Ranibizumab

Topics

• Anesthetics, Local (administration & dosage)
• Angiogenesis Inhibitors (administration & dosage)
• Anti-Bacterial Agents (administration & dosage)
• Antibodies, Monoclonal (administration & dosage)
• Antibodies, Monoclonal, Humanized
• Disinfection (methods)
• Endophthalmitis (epidemiology, microbiology, prevention & control)
• Eye Infections, Bacterial (epidemiology, microbiology, prevention & control)
• Glucocorticoids (administration & dosage)
• Humans
• Incidence
• Injections
• Laser Coagulation
• Macular Degeneration (therapy)
• Methicillin-Resistant Staphylococcus aureus (isolation & purification)
• Povidone-Iodine (administration & dosage)
• Prospective Studies
• Ranibizumab
• Risk Factors
• Staphylococcal Infections (epidemiology, microbiology, prevention & control)
• Streptococcal Infections (epidemiology, microbiology, prevention & control)
• Triamcinolone Acetonide (administration & dosage)
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)
• Viridans Streptococci (isolation & purification)
• Vitreous Body