May 20, 2013
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Antibiotic prophylaxis may have negative effect on safety of intravitreal injections

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MILAN — A low rate of endophthalmitis after anti-VEGF intravitreal injections can be achieved without the use of preoperative and postoperative antibiotics. Antibiotic prophylaxis might, in fact, have a negative impact on the safety of the procedure, according to a speaker here.

Alexander J. Brucker, MD, was awarded the Gian Battista Bietti SOI Medal Lecture 2013 at the annual joint meeting of Ocular Surgery News and the Italian Society of Ophthalmology.

Alexander J. Brucker, MD

Alexander J. Brucker

"We assumed that pre- or postoperative injection antibiotic use might reduce infection rates by sterilizing the conjunctiva, but in fact, antibiotic use may be harmful because, with repeated injections, patients develop ocular surface bacteria that are antibiotic-resistant," Brucker said.

A study at the Bascom Palmer Eye Institute demonstrated that topical antibiotics before the day of injection did not reduce conjunctival bacterial counts more than the immediate pre-injection use of povidone-iodine. A Canadian study based on almost 16,000 injections suggested that the overall rate of intravitreal injection-related endophthalmitis is greater with the use of topical antibiotics compared with no antibiotics.

"In spite of this, the 2011 Patterns and Trends Survey of the American Society of Retina Specialists showed that 27% of retina specialists continue to use pre-injection antibiotics and 63% use post-injection antibiotics," Brucker said.

Respiratory tract organisms of the streptococci species were found to be the most common cause of endophthalmitis with these procedures.

"The only intervention proven to be effective in reducing the risk of infection is the use of topical povidone-iodine, a sterile lid speculum and topical anesthetic," Brucker said.

In addition, he suggested taking precautions against droplet contamination during intravitreal injections by wearing a mask or by not talking with the mouth over the field.

Disclosure: Brucker has no relevant financial disclosures.