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

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

Retina (Philadelphia, Pa.) (2014-12-20)
Abdhish R Bhavsar, Danielle R Sandler
ABSTRACT

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

MATERIALS
Product Number
Brand
Product Description

Triamcinolone acetonide for system suitability, European Pharmacopoeia (EP) Reference Standard
Dexamethasone for peak identification, European Pharmacopoeia (EP) Reference Standard
Ganciclovir, European Pharmacopoeia (EP) Reference Standard
Triamcinolone acetonide, European Pharmacopoeia (EP) Reference Standard
Sigma-Aldrich
Tetracaine, ≥98% (TLC)
Sigma-Aldrich
Ganciclovir, ≥99% (HPLC), powder
Sigma-Aldrich
Dexamethasone 21-phosphate disodium salt, ≥98%
Supelco
Triamcinolone acetonide, analytical standard
USP
Triamcinolone acetonide, United States Pharmacopeia (USP) Reference Standard
Dexamethasone, European Pharmacopoeia (EP) Reference Standard
Dexamethasone sodium phosphate, European Pharmacopoeia (EP) Reference Standard
Sigma-Aldrich
Dexamethasone, powder, BioReagent, suitable for cell culture, ≥97%
Sigma-Aldrich
Dexamethasone, ≥98% (HPLC), powder
Sigma-Aldrich
Dexamethasone, meets USP testing specifications
Sigma-Aldrich
Dexamethasone, powder, γ-irradiated, BioXtra, suitable for cell culture, ≥80% (HPLC)
Sigma-Aldrich
Dexamethasone, tested according to Ph. Eur.
Supelco
Dexamethasone, VETRANAL®, analytical standard
Dexamethasone sodium phosphate for peak identification, European Pharmacopoeia (EP) Reference Standard
USP
Dexamethasone, United States Pharmacopeia (USP) Reference Standard
Dexamethasone, British Pharmacopoeia (BP) Assay Standard
Supelco
Dexamethasone, Pharmaceutical Secondary Standard; Certified Reference Material
Dexamethasone for system suitability, European Pharmacopoeia (EP) Reference Standard