Eliminating antibiotic prophylaxis for intravitreal injections: a consecutive series of 18,839 injections by a single surgeon.

Abstract

PURPOSE:

By optimizing the protocol for intravitreal injections, the risk of endophthalmitis can be minimized. This study assesses the incidence of endophthalmitis and other complications after a consecutive series of intravitreal injections where all antibiotics were excluded.

METHODS:

Injections were performed from August 1, 1997 to October 31, 2012 in outpatient examination rooms at the Retina Center of Minnesota by a single retinal surgeon, the lead author. Most injections were performed to treat exudative age-related macular degeneration. Other reasons included diabetic macular edema, cystoid macular edema because of retinal vein occlusions, cytomegalovirus retinitis, and severe uveitis. Injections were given with topical povidone-iodine, proparacaine, and tetracaine, a sterile eyelid speculum, and clean nonsterile gloves, but without any antibiotics. Data were retrospectively analyzed using billing codes from a computer database system.

RESULTS:

A total of 18,839 injections were given. Of these, the following injections were administered: bevacizumab, 15,479 (82.16%); ranibizumab, 1,669 (8.86%); triamcinolone acetonide (Kenalog-40), 1,014 (5.38%); pegaptanib sodium, 370 (1.96%); aflibercept, 148 (0.79%); dexamethasone implant, 88 (0.47%); triamcinolone acetonide (Triesence), 32 (0.17%); dexamethasone, 29 (0.15%); and ganciclovir, 10 (0.05%). There was one case of postinjection endophthalmitis. The incidence of endophthalmitis per injection was 0.0053%.

CONCLUSION:

A low incidence of endophthalmitis can be achieved when topical antibiotics are omitted.

• Authors: Abdhish R Bhavsar, Danielle R Sandler
• Journal: Retina (Philadelphia, Pa.) (Retina) Vol. 35 Issue 4 Pg. 783-8 (Apr 2015) ISSN: 1539-2864 [Electronic] United States
• PMID: 25526099 (Publication Type: Journal Article)

Chemical References

• Angiogenesis Inhibitors
• Anti-Bacterial Agents
• Glucocorticoids
• Immunosuppressive Agents
• Ophthalmic Solutions

Topics

• Administration, Topical
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Angiogenesis Inhibitors (therapeutic use)
• Anti-Bacterial Agents (administration & dosage)
• Antibiotic Prophylaxis (methods)
• Endophthalmitis (epidemiology, prevention & control)
• Female
• Glucocorticoids (therapeutic use)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Incidence
• Intravitreal Injections
• Male
• Middle Aged
• Minnesota (epidemiology)
• Ophthalmic Solutions
• Practice Patterns, Physicians'
• Retinal Diseases (drug therapy)
• Retrospective Studies