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Viscous topical anesthetics increased risk of post-injection endophthalmitis

Tarek S. Hassan, MD
Tarek S. Hassan

SAN FRANCISCO — Patients with wet age-related macular degeneration and diabetic macular edema who received viscous topical anesthetics before anti-VEGF injections were at increased risk for development of endophthalmitis, according to a speaker.

“The use of lidocaine gel elevated the risk of endophthalmitis by 11 times. The use of tetracaine hypromellose drops increased the risks by four times. All other variables studied were not independent predictors of endophthalmitis,” Tarek S. Hassan, MD, said at Retina Subspecialty Day at the American Academy of Ophthalmology annual meeting.

Hassan and colleagues conducted a retrospective review of eyes diagnosed with endophthalmitis within 15 days of an intravitreal injections. In the review of 98,960 unilateral injections, endophthalmitis developed in 40 eyes.

The researchers used logistic regressions to evaluate association with endophthalmitis of various factors, including use of a lid speculum, use of gloves, a strict no-talking policy, strength of povidone-iodine, use of a thick anesthetic, use of subconjunctival lidocaine, conjunctival displacement, use of topical antibiotics during visit, choice of medication injected and injection site. The only consistent factor in every procedure was that povidone-iodine was given as the final step prior to injection, Hassan said.

Thick topical lidocaine gel and viscous tetracaine liquid hypromellose drops were the only independent factors found to increase the risk of endophthalmitis “likely because it prevents povidone-iodine from fully reaching, maintaining contact with and sterilizing ocular surface tissue before injection,” Hassan said. – by Robert Linnehan

Reference:

Hassan TS. Predictors of post-injection endophthalmitis: A multivariable analysis based on injection protocol and povidone iodine strength. Presented at: American Academy of Ophthalmology annual meeting; October 11-15, 2019; San Francisco.

Disclosure: Hassan reports no relevant financial disclosures.

Tarek S. Hassan, MD
Tarek S. Hassan

SAN FRANCISCO — Patients with wet age-related macular degeneration and diabetic macular edema who received viscous topical anesthetics before anti-VEGF injections were at increased risk for development of endophthalmitis, according to a speaker.

“The use of lidocaine gel elevated the risk of endophthalmitis by 11 times. The use of tetracaine hypromellose drops increased the risks by four times. All other variables studied were not independent predictors of endophthalmitis,” Tarek S. Hassan, MD, said at Retina Subspecialty Day at the American Academy of Ophthalmology annual meeting.

Hassan and colleagues conducted a retrospective review of eyes diagnosed with endophthalmitis within 15 days of an intravitreal injections. In the review of 98,960 unilateral injections, endophthalmitis developed in 40 eyes.

The researchers used logistic regressions to evaluate association with endophthalmitis of various factors, including use of a lid speculum, use of gloves, a strict no-talking policy, strength of povidone-iodine, use of a thick anesthetic, use of subconjunctival lidocaine, conjunctival displacement, use of topical antibiotics during visit, choice of medication injected and injection site. The only consistent factor in every procedure was that povidone-iodine was given as the final step prior to injection, Hassan said.

Thick topical lidocaine gel and viscous tetracaine liquid hypromellose drops were the only independent factors found to increase the risk of endophthalmitis “likely because it prevents povidone-iodine from fully reaching, maintaining contact with and sterilizing ocular surface tissue before injection,” Hassan said. – by Robert Linnehan

Reference:

Hassan TS. Predictors of post-injection endophthalmitis: A multivariable analysis based on injection protocol and povidone iodine strength. Presented at: American Academy of Ophthalmology annual meeting; October 11-15, 2019; San Francisco.

Disclosure: Hassan reports no relevant financial disclosures.

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