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

Abstract

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.

Use of biomaterials for sustained delivery of anti-VEGF to treat retinal diseases

“…These intravitreal injections are now the most commonly performed ophthalmic procedures [2]. However, intravitreal injections are associated with various complications.…”

Outcome of intravitreal bevacizumab injection without pre and postoperative antibiotics

“…P.ET.Lau et al recommended: povidone iodine antisepsis, eyelid retraction with speculum, prevention of droplet spread via masks, adhesive drapes and reduced talking, and subconjunctival anesthetic with lidocaine base agent. The omission of prophylactic topical antibiotics seems justified by the existing literature; however prospective trials are lacking [5].…”

“…Repeated use of antibiotic prophylaxis during monthly intravitreal injections promotes resistance and virulence of conjunctival flora even with low doses and short duration [4]. The rate of endophthalmitis in intravitreal injection is very low but the associated visual morbidity is often devastating [5]. Increased bacterial resistances to pre-operative injection of antibiotics with monthly repeated injection have been described [6].…”

Ocular flora in patients with intravitreal injections and topical antibiotic prophylaxis: antibiotic resistance patterns and susceptibility to antiseptic picloxydine

“…Aseptic and antiseptic techniques include performing injections in the operating rooms, application of povidone-iodine and peri-injection prophylactic treatment with antiseptic drops. Ultraclean air and good ventilation are required in operating rooms [2]. In order to reduce the risk of infection, the spread of pathogens from the oral cavity of patients and medical personnel should be minimized [17] by using sterile masks by surgeons and nurses and sterile adhesive eye drapes that isolate patients' nasopharyngeal area and periocular region [18].…”

“…Infectious complications, associated with IVIs, occur, when a pathogen from the eye surface in the site of the injection penetrates the vitreous capacity. The most dangerous complication is the infectious endophthalmitis with visual impairment threat even in a case of proper and early treatment [1,2].…”