Povidone–iodine Contact Time and Lid Speculum Use During Intravitreal Injection

Friedman, Duncan A.; Mason, John O.; Emond, Tracy L.; McGwin, Gerald

doi:10.1097/iae.0b013e3182877585

Cited by 85 publications

(45 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent prospective, randomized study investigating the contact time (15, 30, 60 s) of 5% PI during 131 IVI showed that a 30-s PI exposure reduced the resident bacterial load significantly compared to 15 s only [88]. This is also confirmed in a laboratory study investigating the bactericidal activity of PI dilute preparations [82].…”

Section: Peri- /Injection Management In Intravitreal Pharmacotherapysupporting

confidence: 65%

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

Section: Peri- /Injection Management In Intravitreal Pharmacotherapysupporting

confidence: 65%

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Friedman et al [114] found a significant reduction in conjunctival bacterial growth after a 30 s exposure to 5% PI, and a further reduction with a 60+ second exposure, while 15 s was inadequate.…”

Section: Reviewmentioning

confidence: 99%

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

Merani

Hunyor

2015

Int J Retin Vitr

View full text Add to dashboard Cite

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.

show abstract

“…There is some concern that the speculum can induce lid squeezing and thus the secretion of infectious organisms from the lid margin. However, Friedman et al found no change in conjunctival cultures after placement of a lid speculum [ 24 ]. While other techniques, such as bimanual retraction, have proven suffi cient, the lid speculum is still common practice for intravitreal injections.…”

Section: Eyelid Speculummentioning

confidence: 98%

Endophthalmitis After Intravitreal Injections

Miller

Haddock

2016

Endophthalmitis

View full text Add to dashboard Cite

Povidone–iodine Contact Time and Lid Speculum Use During Intravitreal Injection

Abstract: The use of 5% PI causes a significant reduction in bacterial colonies, and 30 seconds of exposure appears to be an adequate time to decrease conjunctival bacterial counts. Lid speculum use before intravitreal injection does not affect the overall conjunctival flora.

Cited by 85 publications

References 48 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

Endophthalmitis After Intravitreal Injections

Contact Info

Product

Resources

About