Aqueous Chlorhexidine for Intravitreal Injection Antisepsis

Merani, Rohan; McPherson, Zachary E.; Luckie, Alan; Gilhotra, Jagjit S; Runciman, Jim; Durkin, Shane R.; Muecke, James; Donaldson, Mark J.; Aralar, Albert; Rao, A. Venkateswara; Davies, Peter E.J.

doi:10.1016/j.ophtha.2016.08.022

Cited by 59 publications

(46 citation statements)

References 44 publications

(53 reference statements)

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“…In a recent Australian study comprising 40,535 IVI, chlorhexidine was well tolerated, associated with a low rate of postinjection EO and allergic reaction [94]. Moreover, another recent retrospective case series of 4,322 IVI exclusively performed under chlorhexidine gluconate antisepsis presented an EO rate of 0.023% [95], which is comparable to EO rates using PI [67].…”

Section: Peri- /Injection Management In Intravitreal Pharmacotherapymentioning

confidence: 99%

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

et al. 2018

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Intravitreal injections (IVI) have become the most common intraocular procedure worldwide with increasing numbers every year. The article presents the most up-to-date review on IVI epidemiology and techniques. Unfortunately, important issues related to pre-, peri- and postinjection management lack randomized clinical trials for a final conclusion. Also, a great diversity of approaches exists worldwide. Therefore, expert consensus recommendations on IVI techniques are provided.

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Section: Peri- /Injection Management In Intravitreal Pharmacotherapymentioning

confidence: 99%

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

et al. 2018

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“…In a pain survey scale of 0–10, patient discomfort is reported to be lower (3/10) using chlorhexidine compared with 8/10 using 5% povidone-iodine [ 11 ]. In addition, the efficacy of chlorhexidine is similar to povidone-iodine when investigating ocular bacterial count after antisepsis [ 12 , 13 ]. In a multicentre retrospective case series using aqueous chlorhexidine, the endophthalmitis rate was 0.0074%, which compares favourably with povidone-iodine [ 13 ].…”

Section: Topical Irrigation/antisepsismentioning

confidence: 99%

Current Evidence for the Prevention of Endophthalmitis in Anti-VEGF Intravitreal Injections

Lau

Jenkins

Layton

2018

Journal of Ophthalmology

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Intravitreal injection of a therapeutic substance is the most common procedure performed in ophthalmology. It has a low incidence of serious complications but is associated with a small chance of endophthalmitis. Although the rate of endophthalmitis is between 0.019% and 0.09%, the associated visual morbidity is often devastating. Procedural changes have evolved over the years to improve patient comfort and reduce injection-related injury and infection. Despite the availability of published evidence, there remains considerable variations and lack of consensus in practical clinical settings. In addition, emerging literature concerning the use of speculums, the use of prophylactic topical antibiotics, and the setting of injections continues to impact the ophthalmologist's injection practice. This article provides an up to date assessment of various aspects of the procedure such as the setting, ventilation, type of anaesthetic, and control of sterility during the procedure; including discussions on performing bilateral eye same-day injections and the use of antibiotics.

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“…Safety of CHX solutions for ophthalmic use was proved in experimental settings [ 14 ], and has been considered equally effective to PI in an outpatient study with 87% versus 91% reduction of bacteria [ 7 ]. Recently the safety and adequacy of aqueous chlorhexidine was demonstrated in a multicentre study from Australia where only 3 cases of endophthalmitis were identified in a total of 40,535 intravitreal injection (0.0074%, 1/13512) [ 15 ]. The ocular surface is colonized by bacteria and most post-surgical infections are probably originating from these bacteria.…”

Section: Introductionmentioning

confidence: 99%

Preoperative preparation of eye with chlorhexidine solution significantly reduces bacterial load prior to 23-gauge vitrectomy in Swedish health care

et al. 2018

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BackgroundBacteria in the conjunctiva present a potential risk of vitreous cavity infection during 23-gauge pars plana vitrectomy (PPV). Current preoperative procedures used in Sweden include irrigation with chlorhexidine solution (CHX) 0.05% only and no iodine solutions. We evaluated the bacterial diversity and load before and after this single antibacterial measure.MethodsIn a prospective, consecutive cohort we investigated bacterial growth in samples from 40 eyes in 39 consecutive individuals subjected to vitrectomy. A conjunctival specimen was collected from each preoperative patient before and after irrigating of eye with CHX, 0.05% solution. Iodine was not used during any part of the surgery. One drop of chloramphenicol was administered prior to surgery. Samples from vitreous cavity were collected at the beginning and end of vitrectomy. All conjunctival specimens were cultured for different species and quantified using colony forming units (CFU).ResultsThere was a significant 82% reduction in the total number of CFUs for all bacteria in all eyes (P < 0.0001), and 90% reduction for coagulase negative staphylococci (CoNS) alone (P = 0.0002). The number of eyes with positive bacterial growth in conjunctival samples decreased from 33 to 18 after irrigation with CHX (P = 0.0023). The most common bacteria prior to surgery were CoNS (70%), Propionibacterium acnes (55%) and Corynebacterium species (36%). No case of post-vitrectomy endophthalmitis was reported during mean follow-up time, which was 4.6 ± 2.3 (range; 1.5 to 9) months.ConclusionsPatients undergoing PPV harbored bacteria in conjunctiva capable of causing post-vitrectomy endophthalmitis. Preoperative preparation with CHX significantly reduced the bacterial load in the conjunctival samples subsequently leading to very low inoculation rates in recovered vitreous samples. Thus, CHX used as a single disinfectant agent might be an effective preoperative procedure for eye surgery in Sweden. This is a relatively small study but the results could be a reference for other intraocular surgeries.

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Aqueous Chlorhexidine for Intravitreal Injection Antisepsis

Abstract: Aqueous chlorhexidine was associated with a low rate of postinjection endophthalmitis and was well tolerated by patients.

Cited by 59 publications

References 44 publications

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

Current Evidence for the Prevention of Endophthalmitis in Anti-VEGF Intravitreal Injections

Preoperative preparation of eye with chlorhexidine solution significantly reduces bacterial load prior to 23-gauge vitrectomy in Swedish health care

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