Endophthalmitis Associated With Intravitreal Injections

Tabandeh, Homayoun; Boscia, Francesco; Sborgia, Alessandra; Ciracì, Lorenza; Dayani, Pouya N.; Mariotti, Cesare; Furino, Claudio; Flynn, Harry W.

doi:10.1097/iae.0000000000000008

Cited by 73 publications

(38 citation statements)

References 33 publications

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“…This has also been confirmed by a literature review summarizing data of 445,503 IVI, which did not show a significant difference between OR [71, 72, 78, 79] and office-based IVI [67-70]. …”

Section: Peri- /Injection Management In Intravitreal Pharmacotherapymentioning

confidence: 54%

“…A consecutive case series including a total of 11,710 IVI and comparing office-based (8,647) and OR (3,063) settings reported no significant difference in EO rates (0.035 and 0.065%, respectively) [78]. This has also been confirmed by a literature review summarizing data of 445,503 IVI, which did not show a significant difference between OR [71, 72, 78, 79] and office-based IVI [67-70].…”

Section: Peri- /Injection Management In Intravitreal Pharmacotherapymentioning

confidence: 99%

See 1 more Smart Citation

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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“…This has also been confirmed by a literature review summarizing data of 445,503 IVI, which did not show a significant difference between OR [71, 72, 78, 79] and office-based IVI [67-70]. …”

Section: Peri- /Injection Management In Intravitreal Pharmacotherapymentioning

confidence: 54%

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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“…The difference in endophthalmitis rates may be a reflection of socioeconomic or other factors [39]. Tabendeh et al [30] reported an endophthalmitis rate of 3/8,210 (0.037%) anti-VEGF injections in the office compared with 2/3,047 in the operating room (0.066%), in another non-randomised study that was not powered to be able to detect a difference. Compared with office-based injections, there was no apparent benefit to an OR environment in this small study.…”

Section: Reviewmentioning

confidence: 99%

“…Delayed-onset bleb-related endophthalmitis is also associated with a disproportionately higher rate of Streptococcal infection. This may be the result of alterations in the resident flora or structural changes in the eye wall, and such changes may also occur in some eyes after multiple intravitreal injections [30, 84–86]. …”

Section: Reviewmentioning

confidence: 99%

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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“…Elevation of IOP that is recalcitrant to maximal medical therapy can be successfully managed by vitrectomy to remove the steroid from the eye [77]. Endophthalmitis after intravitreal injection of IVTA is reported to occur at a similar rate as after other intravitreal injections with no difference in the rate in the office versus operating room settings and an overall rate of endophthalmitis after intravitreal injection of 0.043 % [78]. No benefit is found with topical antibiotics before or after intravitreal injections and there is a trend toward an increase in the rate of endophthalmitis with the use of topical antibiotics [79,80].…”

Section: Triamcinolone Acetonidementioning

confidence: 99%

Corticosteroids for the Treatment of Diabetic Macular Edema

Sharma

Mruthyunjaya

2014

Curr Ophthalmol Rep

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Diabetic macular edema (DME) is a leading cause of vision loss throughout the world. Three different corticosteroids have been used in the treatment of diabetic macular edema: triamcinolone acetonide, dexamethasone, and fluocinolone acetonide. Intravitreal injection of all three corticosteroids is associated with a similar side effect profile including worsening/formation of cataract, elevation of intraocular pressure, pseudo-endophthalmitis, and infectious endophthalmitis. Sustained-release implants of corticosteroids have recently been studied, and one has recently received FDA approval as the first corticosteroid for the treatment of diabetic macular edema. This review will address some of the major studies evaluating corticosteroids for DME and will focus on studies published within the last 2 years.

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Endophthalmitis Associated With Intravitreal Injections

Abstract: The rate of clinically suspected endophthalmitis after IVIs is low whether the procedure is performed in the office or operating room setting. The findings have implications in terms of the patient convenience, efficiency, and cost of administrating these treatments.

Cited by 73 publications

References 33 publications

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

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

Corticosteroids for the Treatment of Diabetic Macular Edema

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