Reducing endophthalmitis risk with intravitreal injections

EURETINA initiative publishes expert consensus recommendations to guide members

Dermot McGrath

Posted: Monday, March 4, 2019

Andrzej Grzybowski MD, PhD

With intravitreal injections now one of the most commonly used ophthalmic procedures, there are certain straightforward measures that can be taken to reduce the risk of post-intravitreal injection-related endophthalmitis, Andrzej Grzybowski MD, PhD told delegates attending the 9th EURETINA Winter Meeting in Prague.

The reported cumulative endophthalmitis incidence related to intravitreal injections (IVI) is around 0.048% based on different studies carried out between 2011 and 2018, although there is considerable disparity between different studies, noted Dr Grzybowski.

As part of a EURETINA initiative, Dr Grzybowski and colleagues recently published expert consensus recommendations to guide members.

In terms of the ideal clinical setting for IVI, operating theatre, adequate room or in-office settings are all recommended. It is also advised to administer 5% povidone-iodine antisepsis for a minimum of 30 seconds.

“In fact, this is the only intervention that has been demonstrated by a randomised controlled trial to reduce the risk of postoperative endophthalmitis,” noted Dr Grzybowski. Chlorhexidine may also be used for patients that are sensitive to povidone-iodine.

By contrast, perioperative antibiotics are not recommended as part of the guidelines, with pooled estimates of the risk of endophthalmitis after IVI found to be three times higher when they were used.

“Frequent use of topical antibiotics promotes increasing antibiotic resistance and growth of pan-drug-resistant bacteria leading to more severe endophthalmitis cases,” said Dr Grzybowski.

Other measures recommended in the guidelines include the use of a sterile lid speculum, appropriate clothing and the use of face masks.