Abdhish R Bhavsar1, Danielle R Sandler. 1. *Retina Center of Minnesota, Minneapolis, Minnesota; and †Midwestern University, Glendale, Arizona.
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.
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: Samir N Patel; Jason Hsu; Meera D Sivalingam; Allen Chiang; Richard S Kaiser; Sonia Mehta; Carl H Park; Carl D Regillo; Arunan Sivalingam; James F Vander; Allen C Ho; Sunir J Garg Journal: Am J Ophthalmol Date: 2020-09-02 Impact factor: 5.258