Risk of Endophthalmitis After Intravitreal Drug Injection When Topical Antibiotics Are Not Required

Publisher Website
Google Scholar
Abstract
Intravitreal injections have become an increasingly common route of administration of medications in the treatment of posterior segment disease. Endophthalmitis is one of the most serious complications of intravitreal injection of medication, with a reported per-injection incidence that ranges from 0.02% to 1.9%.1-5 Optimum management of the ocular surface before, during, and after intravitreal injections remains controversial.3,6 A topical combination of povidone-iodine is the only preoperative substance proven in a randomized clinical trial to reduce the risk of endophthalmitis after intraocular surgery.7 To our knowledge, no adequate studies have evaluated the role of topical antibiotics; thus, uncertainty still exists with regard to the efficacy of topical antibiotics in the prevention of postinjection endophthalmitis. Although combined use of topical povidone-iodine and antibiotics may have a synergistic effect in reduction of the preoperative culture-positive rate of the conjunctival surface,8,9 we have identified little evidence that suggests topical antibiotics reduce the rate of endophthalmitis in humans. In addition, there is little evidence that the pharmacokinetics of the topical regimens provided would result in adequate antibiotic levels, which would be expected to have a protective effect.10-13 Despite this, topical antibiotics before intravitreal drug injection have been required in several recent clinical trial protocols.14-16 Furthermore, recent surveys have suggested that 40% of retina specialists use topical antibiotics before anti–vascular endothelial growth factor intravitreal injections, and 86% use topical antibiotics after anti–vascular endothelial growth factor intravitreal injections.17,18