Rohan Merani1, Zachary E McPherson2, Alan P Luckie3, Jagjit S Gilhotra4, Jim Runciman5, Shane Durkin5, James Muecke5, Mark Donaldson6, Albert Aralar6, Anupam Rao7, Peter E Davies8. 1. Save Sight Institute, University of Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, NSW, Australia; Concord Repatriation General Hospital, Concord NSW, Australia; Retina Associates, Chatswood, NSW, Australia. 2. The University of Newcastle, Newcastle, NSW, Australia. 3. Eye Clinic Albury Wodonga, Albury, NSW, Australia. 4. South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, SA, Australia; Adelaide Eye and Retina Centre, Adelaide, SA, Australia. 5. Adelaide Eye and Retina Centre, Adelaide, SA, Australia. 6. Terrace Eye Centre, Brisbane, Qld, Australia. 7. Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia. 8. The University of Newcastle, Newcastle, NSW, Australia; Newcastle Eye Hospital, Newcastle, NSW, Australia. Electronic address: drpeterdavies@bigpond.com.
Abstract
PURPOSE: To determine the incidence of endophthalmitis in a large clinical series using aqueous chlorhexidine for antisepsis before intravitreal injection and to review the ophthalmic literature regarding chlorhexidine efficacy and safety. DESIGN: Multicenter retrospective case series. PARTICIPANTS: All patients receiving intravitreal injections from 7 retinal specialists. METHODS: An audit of intravitreal injections performed by retinal specialists who exclusively used aqueous chlorhexidine 0.05% or 0.1% for prophylaxis of infective endophthalmitis was undertaken. The incidence of endophthalmitis was determined from August 1, 2011, to February 28, 2015. A literature review was performed to critically appraise the ocular safety and efficacy of aqueous chlorhexidine. MAIN OUTCOME MEASURES: Incidence of endophthalmitis after intravitreal injections. RESULTS: A total of 40 535 intravitreal injections were performed by 7 retinal specialists across 3 centers. Chlorhexidine was well tolerated, and only 1 patient with a suspected allergic reaction was noted. Three cases of endophthalmitis were identified with 1 culture-positive case. The 0.0074% (1 in 13 512) per-injection rate of endophthalmitis in this series compares favorably with previous series in which povidone-iodine has been used. CONCLUSIONS: Aqueous chlorhexidine was associated with a low rate of postinjection endophthalmitis and was well tolerated by patients.
PURPOSE: To determine the incidence of endophthalmitis in a large clinical series using aqueous chlorhexidine for antisepsis before intravitreal injection and to review the ophthalmic literature regarding chlorhexidine efficacy and safety. DESIGN: Multicenter retrospective case series. PARTICIPANTS: All patients receiving intravitreal injections from 7 retinal specialists. METHODS: An audit of intravitreal injections performed by retinal specialists who exclusively used aqueous chlorhexidine 0.05% or 0.1% for prophylaxis of infective endophthalmitis was undertaken. The incidence of endophthalmitis was determined from August 1, 2011, to February 28, 2015. A literature review was performed to critically appraise the ocular safety and efficacy of aqueous chlorhexidine. MAIN OUTCOME MEASURES: Incidence of endophthalmitis after intravitreal injections. RESULTS: A total of 40 535 intravitreal injections were performed by 7 retinal specialists across 3 centers. Chlorhexidine was well tolerated, and only 1 patient with a suspected allergic reaction was noted. Three cases of endophthalmitis were identified with 1 culture-positive case. The 0.0074% (1 in 13 512) per-injection rate of endophthalmitis in this series compares favorably with previous series in which povidone-iodine has been used. CONCLUSIONS: Aqueous chlorhexidine was associated with a low rate of postinjection endophthalmitis and was well tolerated by patients.
Authors: William Swift; Jeffrey A Bair; Wanxue Chen; Michael Li; Sole Lie; Dayu Li; Menglu Yang; Marie A Shatos; Robin R Hodges; Miriam Kolko; Tor P Utheim; Wendell Scott; Darlene A Dartt Journal: BMJ Open Ophthalmol Date: 2020-09-16