Incidence of endophthalmitis after intravitreal injection with and without topical antibiotic prophylaxis

Abstract

Purpose: The purpose was to compare the incidence of endophthalmitis after intravitreal injection with and without topical antibiotic prophylaxis. Methods: This is a single-center, retrospective case–control study. All patients treated with intravitreal injection of ranibizumab, bevacizumab, aflibercept, or corticosteroids for a variety of retinal vascular diseases between 1 October 2014 and 30 November 2018 were included. The total number of patients and injections were determined from a review of billing code and practice management records. Endophthalmitis cases were determined from billing records and then confirmed with chart review. A 24-month period when topical antibiotics were prescribed after intravitreal injection was compared with a 24-month period when topical antibiotics were not prescribed. Results: Between 1 October 2014 and 30 November 2018, a total of 33,515 intravitreal injections were performed and 13 cases of post–intravitreal injection endophthalmitis were identified (incidence rate of 0.0388%; 95% confidence interval, 0.0217%–0.0644%) or approximately 1 case for every 2578 intravitreal injections. Between 1 October 2014 and 31 October 2016, while topical antibiotic prophylaxis was used postoperatively, 14,828 intravitreal injections were performed and 5 cases of endophthalmitis were reported (0.0337%; 95% confidence interval, 0.0129%–0.0739%). Between 1 November 2016 and 30 November 2018, while no prophylaxis was used, 18,687 intravitreal injections were performed and 8 cases of endophthalmitis were identified (0.0428%; 95% confidence interval, 0.0202%–0.0808%). There were no statistical differences in the incidence rates between the two groups ( p = 0.675). Conclusion: The incidence rate of endophthalmitis in the group with topical antibiotic prophylaxis after intravitreal injection was similar to the group with no prophylaxis. Changing the current clinical practice to no antibiotic prophylaxis had no effect on the incidence of endophthalmitis.

Efficacy of a New Commercial Ocular Spray Containing Oftasecur Citrus Extract for Reducing Microbial Load in the Conjunctiva of Patients Receiving Intravitreal Injections

“…In order to reduce this risk, several preventive treatment options have been investigated [ 9 ]; among them, the use of povidone-iodine eye drops in combination with strict antisepsis rules is the only prophylactic modality which has been shown to be effective in reducing endophthalmitis incidence after intraocular surgery [ 10 ].…”

“…Currently, other ancillary prophylactic agents are still needed in order to further reduce the incidence of endophthalmitis after IVTs. In this regard, flavonoids have been shown to exert direct antioxidant and free radical scavenging activity [ 9 ]. Furthermore, these natural compounds display a wide spectrum of biological functions, including antibacterial activity against several forms of Gram-negative bacteria [ 11 ].…”

Incidence of Endophthalmitis after Intravitreal Anti-Vascular Endothelial Growth Factor Injections in an Operating Room in China

“…e PAT survey reveals a decline in topical antibiotics over the years. Based on many newer published series of intravitreal injections without topical antibiotics [8,9], it is possible that non-US ophthalmologists will increasingly forgo topical antibiotics with intravitreal injections.…”

“…Meanwhile, intravitreal injections performed in the office setting achieved a comparatively low EO rate (0.009%) in a retrospective review of 10,142 consecutive cases [5]. Topical antibiotic prophylaxis is still controversial [6,7], but more and more studies report low EO incidence without prophylaxis [8,9]. In one study, the EO rate in the group with topical antibiotic prophylaxis after intravitreal injection was similar to that in the group without prophylaxis [8].…”

“…Topical antibiotic prophylaxis is still controversial [6,7], but more and more studies report low EO incidence without prophylaxis [8,9]. In one study, the EO rate in the group with topical antibiotic prophylaxis after intravitreal injection was similar to that in the group without prophylaxis [8]. Using conjunctival sac irrigation with 0.25% povidone-iodine (PVI) before and after intravitreal injection, the EO incidence (0/12,523, 95% CI 0-0.00024%) remained low without pre-or post-injection topical antibiotics in a Japanese study [9].…”