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Update on Risk of Endophthalmitis After Intravitreal Drug Injections and Potential Impact of Elimination of Topical Antibiotics

Abdhish R. Bhavsar, MD; Cynthia R. Stockdale, MSPH; Frederick L. Ferris, MD; Alexander J. Brucker, MD; Neil M. Bressler, MD; Adam R. Glassman, MS; for the Diabetic Retinopathy Clinical Research Network
Arch Ophthalmol. 2012;130(6):809-810. doi:10.1001/archophthalmol.2012.227.
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Previously, the Diabetic Retinopathy Clinical Research Network reported a low rate of endophthalmitis achieved after intravitreal injection via a protocol requiring topical povidone-iodine, a sterile eyelid speculum, and topical anesthetic and not requiring topical antibiotics, sterile gloves, or a sterile drape.1 These results included 3838 injections of either ranibizumab or preservative-free triamcinolone acetonide. No antibiotics were given either before or after the injections in 1276 eyes. Of 3226 ranibizumab injections given between 2 Diabetic Retinopathy Clinical Research Network randomized trials, 3 cases of endophthalmitis occurred, all in eyes receiving topical antibiotics for several days after the injection.


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Endophthalmitis in intravitral injections
Posted on July 22, 2012
Ramesh Sivaraj
Heart of England NHS Foundation Trust
Conflict of Interest: None Declared
Dear Dr Bhavsar et al,Thank you for your article. I was wondering if you encountered any patients with iodine allergy as these patients cannot have povidone prophylaxis preceding an intravitreal injection. There are some reports mentioning documented iodine allergy is not a contraindication for povidone use1. Is there a subgroup of your patients which did not receive povidone and if so did that influence the incidence of endophthalmitis.1. http://www.retinalphysician.com/articleviewer.aspx?articleid=1034552. Caldwell DR, Kastl PR, Cook J, Simon J. Povidone-iodine: its efficacy as a preoperative conjunctival and periocular preparation. Ann Ophthalmol. 1984;16: 577, 580.3. Apt L, Isenberg S, Yoshimori R, Paez JH. Chemical preparation of the eye In ophthalmic surgery. III. Effect of povldone-iodlne on the conjunctiva. Arch Ophthalmol. 1984;102:728-729.4. Isenberg SJ, Apt L, Yoshimorl R, Khwarg S. Chemical preparation of the eye In ophthalmic surgery. IV Comparison of povldone-iodlne on the conjunctiva with a prophylactic antibiotic. Arch Ophthalmol. 1985;103:1340-1342.
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