Study: Endophthalmitis low despite antibiotic-free intravitreal injection

Minneapolis-Analyses of safety data from Diabetic Retinopathy Clinical Research Network (DRCR.net) trials show a very low rate of endophthalmitis can be achieved in eyes receiving intravitreal drug injections using a protocol that does not use topical antibiotics, said Abdhish R. Bhavsar, MD.

“Our current data suggest that it is extremely unlikely that omitting topical antibiotics prior to, on the day of, or after intravitreal injection leads to a moderate or large increase in the risk of endophthalmitis,” said Dr. Bhavsar, private practice, Minneapolis. “In fact, the data suggest that topical antibiotic use might be associated with an increased risk of endophthalmitis, which potentially may be due to additional manipulation of the ocular surface when applying the medication or other unknown causes.

“Whether all three of the components of the DRCR.net injection technique, or any one in particular, are related to the low rate of endophthalmitis is not known,” he added.

Eyes that were administered an intravitreal injection received a topical anesthestic, had a sterile lid speculum placed, and were prepped with topical povidone-iodine to the conjunctival surface. However, per the DRCR.net protocol, sterile draping was not required, and surgeons did not need to wear sterile gloves or a face mask.

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Cases of endophthalmitis were identified among patients receiving intravitreal injections across six different DRCR.net trials.

A total of 12,445 injections were administered in 1,975 eyes, of which 6,515 were performed with topical antibiotic use and 5,930 with no topical antibiotic. There were 8 cases of endophthalmitis in the series, of which 7 (0.11%) occurred in eyes that received topical antibiotics and 1 was in the group that had no antibiotic treatment (0.02%).

In one of the endophthalmitis cases, the povidone-iodine prep had been omitted.

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