TIPS AND TRICKS FOR SUCCESSFUL INTRAVITREOUS INJECTIONS AND RETINA SURGERY

JUNE 12TH, 2021

It all begins with an idea. The povidone iodine prep is the most important item for antisepsis prior to intravitreous injections.

Here is an abstract from:

Retina. 2015 Apr;35(4):783-8.doi: 10.1097/IAE.0000000000000392.

Eliminating antibiotic prophylaxis for intravitreal injections: a consecutive series of 18,839 injections by a single surgeon

Abdhish R Bhavsar 1 , Danielle R Sandler

Abstract

Purpose: By optimizing the protocol for intravitreal injections, the risk of endophthalmitis can be minimized. This study assesses the incidence of endophthalmitis and other complications after a consecutive series of intravitreal injections where all antibiotics were excluded.

Methods: Injections were performed from August 1, 1997 to October 31, 2012 in outpatient examination rooms at the Retina Center of Minnesota by a single retinal surgeon, the lead author. Most injections were performed to treat exudative age-related macular degeneration. Other reasons included diabetic macular edema, cystoid macular edema because of retinal vein occlusions, cytomegalovirus retinitis, and severe uveitis. Injections were given with topical povidone-iodine, proparacaine, and tetracaine, a sterile eyelid speculum, and clean nonsterile gloves, but without any antibiotics. Data were retrospectively analyzed using billing codes from a computer database system.

Results: A total of 18,839 injections were given. Of these, the following injections were administered: bevacizumab, 15,479 (82.16%); ranibizumab, 1,669 (8.86%); triamcinolone acetonide (Kenalog-40), 1,014 (5.38%); pegaptanib sodium, 370 (1.96%); aflibercept, 148 (0.79%); dexamethasone implant, 88 (0.47%); triamcinolone acetonide (Triesence), 32 (0.17%); dexamethasone, 29 (0.15%); and ganciclovir, 10 (0.05%). There was one case of postinjection endophthalmitis. The incidence of endophthalmitis per injection was 0.0053%.

Conclusion: A low incidence of endophthalmitis can be achieved when topical antibiotics are omitted.