September 4, 2015
Guidelines for intravitreal injections are continuously evolving, and the latest advice surprisingly tells retina specialists to avoid antibiotic drops before, during and after intravitreal injections. This counterintuitive advice comes as the result of several studies looking at factors that correlate with infections post-intravitreal drug delivery. Evidence shows no lower rate of endophthalmitis when antibiotics are used, and, in fact, the organisms that develop are more resistant among antibiotic-treated patients.
Treatment with intravitreal drugs is still in its infancy, as cancer treatment was 50 years ago. When we had one or two chemotherapy agents, there was little question as to which drugs to choose. Until the discovery of pulsed-dosing and adjunctive drugs that mitigate the chemotherapy side effects, treatment was even more unpleasant, and often more lethal, than it is today. Where intravitreal injections are concerned, there is an array of both new products/mechanisms and new dosing regimens. Treat-and-extend is now standard of care, having retina specialists stretch out the course of treatment as vessel regression occurs.