What is the Risk of Infection With Intravitreal Drug Injections Without Topical Antibiotics?

December 21, 2009

As reported on MedPage Today, a recent randomized clinical trial showed that intravitreal drug injections led to an infection rate of less than one in 1,000 with a protocol that consisted of a sterile-lid speculum, topical povidone-iodine, and a topical anesthetic, but that avoided topical antibiotics.

Specifcally, a total of 3,838 intravitreal injections were administered to 733 eyes by 124 physicians. The total comprised 612 injections of triamcinolone in 272 eyes and 3,226 injections of ranibizumab in 461 eyes. Topical antibiotics were administered on the day of injection in 9.4% of the cases; for several days after injection in 21.2% of cases; and on the day of injection and afterward in 36.2%. In the remaining 33.3% (1,276 cases), no antibiotics were administered.

Only three cases of culture-positive endophthalmitis occurred following ranibizumab injections, and none with the triamcinolone injections.

The results of the trial were published in the December issue of Archives of Ophthalmology. The authors of the article noted that while intravitreal injection has become standard for treatment of posterior segment disease, and reported rates of endophthalmitis after injection have been low, there was no consensus regarding optimal management of the ocular surface before, during, and after injection. In particular, no compelling evidence supported topical antibiotics.

Read further details about the trial and protocols on MedPage Today.




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One Response to “What is the Risk of Infection With Intravitreal Drug Injections Without Topical Antibiotics?”

  • While there may be no consensus regarding intravitreal injections, I am grateful for a study that starts us off in the right direction. There is lots of “magic” in many of the things we do (by “magic,” I mean things we do “just because” and without any real evidence) in ophthalmology.

    I personally use antibiotics for the theoretical advantage of decreasing bacterial load, and, also use it to get the patient to engage in their own procedure.

    After this article, I am making a few changes in my own regimen, for instance, soaking the cotton in anesthetic and antiseptic.