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.
RCT Entities:
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: Lloyd P Aiello; Alexander J Brucker; Stanley Chang; Emmett T Cunningham; Donald J D'Amico; Harry W Flynn; Lisa R Grillone; Steve Hutcherson; Jeffrey M Liebmann; Terrence P O'Brien; Ingrid U Scott; Richard F Spaide; Christopher Ta; Michael T Trese Journal: Retina Date: 2004-10 Impact factor: 4.256
Authors: Christopher N Ta; Peter R Egbert; Kuldev Singh; Erin M Shriver; Mark S Blumenkranz; Herminia Miño De Kaspar Journal: Ophthalmology Date: 2002-11 Impact factor: 12.079
Authors: Philip J Rosenfeld; David M Brown; Jeffrey S Heier; David S Boyer; Peter K Kaiser; Carol Y Chung; Robert Y Kim Journal: N Engl J Med Date: 2006-10-05 Impact factor: 91.245
Authors: Adam Martidis; Jay S Duker; Paul B Greenberg; Adam H Rogers; Carmen A Puliafito; Elias Reichel; Caroline Baumal Journal: Ophthalmology Date: 2002-05 Impact factor: 12.079
Authors: Seenu M Hariprasad; Kevin J Blinder; Gaurav K Shah; Rajendra S Apte; Brett Rosenblatt; Nancy M Holekamp; Matthew A Thomas; William F Mieler; Jingduan Chi; Randall A Prince Journal: Arch Ophthalmol Date: 2005-01
Authors: Evangelos S Gragoudas; Anthony P Adamis; Emmett T Cunningham; Matthew Feinsod; David R Guyer Journal: N Engl J Med Date: 2004-12-30 Impact factor: 91.245
Authors: David R Fintak; Gaurav K Shah; Kevin J Blinder; Carl D Regillo; John Pollack; Jeffrey S Heier; Hussein Hollands; Sanjay Sharma Journal: Retina Date: 2008 Nov-Dec Impact factor: 4.256
Authors: Abdhish R Bhavsar; Cynthia R Stockdale; Frederick L Ferris; Alexander J Brucker; Neil M Bressler; Adam R Glassman Journal: Arch Ophthalmol Date: 2012-06
Authors: Ludimila L Cavalcante; Milena L Cavalcante; Timothy G Murray; Michael M Vigoda; Yolanda Piña; Christina L Decatur; R Prince Davis; Lisa C Olmos; Amy C Schefler; Michael B Parrott; Kyle J Alliman; Harry W Flynn; Andrew A Moshfeghi Journal: Clin Ophthalmol Date: 2010-05-25