Antibacterial Properties of 2% Lidocaine and Reduced Rate of Endophthalmitis After Intravitreal Injection

Tustin, Aaron W; Kim, Stephen J.; Chomsky, Amy; Hubbard, G. Baker; Sheng, Jinsong

doi:10.1097/iae.0000000000000014

Cited by 21 publications

(17 citation statements)

References 18 publications

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“…Even though masks are not used, talking during the procedure is avoided, as supported by previous studies that showed that wearing masks and avoiding talking had a similar reduction in bacterial contamination [25, 26]. In addition, our case of endophthalmitis did not receive subconjunctival anesthesia, but there are data suggesting that subconjunctival lidocaine 2% can have antibacterial properties and reduces the rate of infectious endophthalmitis [27]. Finally, pre and postinjection antibiotics are not routinely used in our practice, supported by data suggesting that the use of antibiotics does not lower the incidence of endophthalmitis and may contribute to development of a drug-resistant conjunctival flora [22, 23].…”

Section: Discussionsupporting

confidence: 65%

Same-Day Bilateral Intravitreal Anti-Vascular Endothelial Growth Factor Injections: Experience of a Large Canadian Retina Center

et al. 2019

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Objective: To evaluate the outcomes and complications of bilateral same-day intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. Methods: This is a single-center, retrospective study that included 524 eyes of 262 patients who received concomitant bilateral intravitreal anti-VEGF injections in 2016 at St. Michael’s Hospital, Toronto. If any of the patients were receiving simultaneous bilateral injections on a regular basis prior to 2016, data pertaining to previous injections were also reviewed. Everyone received bevacizumab, ranibizumab, or aflibercept in an office setting. Results: A total of 9,798 intravitreal anti-VEGF injections (4,899 bilateral injection sessions) were performed in 524 eyes of 262 patients. The average number of bilateral injection sessions per patient was 18.7 ± 14.1. Ranibizumab was the most commonly used anti-VEGF drug (83.8%). The incidence of endophthalmitis was 0.01%, and there were 2 episodes of acute intraocular inflammation among the 9,798 injections (0.02%). All 3 cases occurred after treatment with ranibizumab. There were 2 deaths (0.76%) due to nonvascular causes but no vascular related systemic adverse events were reported. Conclusions: Same-day bilateral intravitreal anti-VEGF injections present a low rate of complications and are well tolerated by patients. This safe practice may reduce the burden on the health-care system and on the patients.

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Section: Discussionsupporting

confidence: 65%

Same-Day Bilateral Intravitreal Anti-Vascular Endothelial Growth Factor Injections: Experience of a Large Canadian Retina Center

et al. 2019

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“…In a retrospective series, Tustin et al reported a rate of endophthalmitis of 8/8,189 (0.1%) when subconjunctival lidocaine was not used, compared with 0/6,853 when it was used (P = 0.03), suggesting that the use of subconjunctival anesthetic may reduce the risk of endophthalmitis [143]. However, 14 culture-negative cases of “possible” endophthalmitis were excluded, nine of which were after injection of triamcinolone and five after bevacizumab.…”

Section: Reviewmentioning

confidence: 99%

“…However, 14 culture-negative cases of “possible” endophthalmitis were excluded, nine of which were after injection of triamcinolone and five after bevacizumab. The same authors found that 2% lidocaine/0.1% methylparaben demonstrated rapid bactericidal effects against S. aureus , S. epidermidis and S. viridans in vitro [143]. …”

Section: Reviewmentioning

confidence: 99%

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Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review

Merani

Hunyor

2015

Int J Retin Vitr

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The purpose of this review is to report and summarize previously reported studies and assess many of the individual steps of the intravitreal injection procedure’s possible effect on the prevention of endophthalmitis. The pooled endophthalmitis rate from 20 large retrospective case series of anti-VEGF injections was 144/510,396 (0.028%; 1/3,544). Injections may be performed in an office-based location or in an operating room (OR) and low rates of endophthalmitis can be achieved in either location with careful attention to asepsis. Pre- or post-injection topical antibiotics have not been shown to be effective, and could select for more virulent microorganisms. Povidone-iodine prior to injection is accepted as the gold-standard antiseptic agent, but aqueous chlorhexidine may be an alternative. Antisepsis before and after gel or subconjunctival anesthetic is suggested. The preponderance of Streptococcal infections after intravitreal injection is discussed, including the possible role of aerosolization, which can be minimized by using face masks or maintaining silence. As with other invasive procedures in medicine, the use of sterile gloves, following adequate hand antisepsis, may be considered. Control of the eyelashes and lid margin is required to avoid contamination of the needle, but this can be achieved with or without a speculum. Techniques to minimize vitreous reflux have not been shown to reduce the risk of endophthalmitis. Same day bilateral injections should be performed as two separate procedures, preferably using drug from different lots, especially when using compounded drugs.

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“…Subconjunctival lidocaine may play a role in the low endophthalmitis rates observed in our study; however, this is not explicitly stated in the 2014 recommendations by Avery et al 23. Tustin et al performed in vitro experiments to determine the antibacterial properties of 2% lidocaine/0.1% methylparaben (lidocaine) against causative organisms of endophthalmitis ( Staphylococcus aureus , S. epidermidis and Streptococcus viridans ) 24. Lidocaine demonstrated rapid bactericidal effects against all three organisms.…”

Section: Discussionmentioning

confidence: 55%

Lid splinting eyelid retraction technique: a minimised sterile approach for intravitreal injections

et al. 2017

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The technique of eyelid retraction for intravitreal injection has a low rate of endophthalmitis, similar to the reported rates using a metal lid speculum. This is beneficial for both the physician and the patient as it minimises patient discomfort as well as the duration of the procedure. To our knowledge, this is one of the largest studies performed to date evaluating intravitreal injection-related endophthalmitis.

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Antibacterial Properties of 2% Lidocaine and Reduced Rate of Endophthalmitis After Intravitreal Injection

Abstract: Application of subconjunctival 2% lidocaine/0.1% methylparaben for anesthesia may reduce the incidence of endophthalmitis after IVT injection.

Cited by 21 publications

References 18 publications

Same-Day Bilateral Intravitreal Anti-Vascular Endothelial Growth Factor Injections: Experience of a Large Canadian Retina Center

Same-Day Bilateral Intravitreal Anti-Vascular Endothelial Growth Factor Injections: Experience of a Large Canadian Retina Center

Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review

Lid splinting eyelid retraction technique: a minimised sterile approach for intravitreal injections

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