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No increase in incidence of post-intravitreal injection endophthalmitis without topical antibiotics: a prospective study

  • Clinical Investigation
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Japanese Journal of Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

In our previous report, intravitreal injection using 0.25% povidone-iodine to irrigate the conjunctival sac together with pre- and post-injection topical antibiotics achieved an incidence of post-injection endophthalmitis significantly lower than other reports. In this study, we examined whether similarly low incidence is achieved without using any topical antibiotics.

Study design

Prospective cohort study.

Methods

We evaluated intravitreal injections of anti-vascular endothelial growth factor agents conducted by vitreoretinal specialists at the outpatient injection room of a single university hospital. This study had two protocols. First stage: We performed more than 3000 injections with pre-injection but without post-injection topical antibiotics. Final stage: After confirming no case of endophthalmitis in the first stage, we performed more than 12,500 injections without either pre- or post-injection topical antibiotics. In both protocols, we used 0.25% povidone-iodine to sterilize the conjunctival sac both before and after injection.

Results

First stage was performed between April 2015 and January 2016. No case of suspected or proven infectious endophthalmitis occurred in 6039 injections [95% confidence interval (CI) 0–0.000497%]. Final stage was performed between February 2016 and November 2017. No case of suspected or proven infectious endophthalmitis occurred in 12,523 injections (95% CI 0–0.00024%). This result was comparable to our previous study using both pre- and post-injection topical antibiotics (0/15,144 injections, 95% CI 0–0.000198%).

Conclusion

Using conjunctival sac irrigation with 0.25% povidone-iodine before and after intravitreal injection, the incidence of endophthalmitis remains low even when the use of pre- or post-injection topical antibiotics is discontinued.

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Acknowledgements

Conception and design (KT, HS); analysis and interpretation (KT, HS, RM); writing the manuscript (KT, HS); critical revision of the article (KT, HS, RM, HN, TH, YO); final approval of the article (KT, HS, RM, HN, TH, YO); data collection (KT, HS); provision of materials (KT); statistics (KT); literature search (YO), administrative, technical or logistic support (HN, TH, YO).

Funding

This study was financed by regular departmental research funds.

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Authors and Affiliations

  1. Department of Ophthalmology, School of Medicine, Nihon University Hospital, 1-6 Surugadai, Kanda, Chiyodaku, Tokyo, 101-8309, Japan

    Koji Tanaka, Hiroyuki Shimada, Ryusaburo Mori, Hiroyuki Nakashizuka, Takayuki Hattori & Yuko Okubo

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  1. Koji Tanaka
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  2. Hiroyuki Shimada
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  3. Ryusaburo Mori
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  4. Hiroyuki Nakashizuka
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  6. Yuko Okubo
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Corresponding author

Correspondence to Hiroyuki Shimada.

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Conflicts of interest

K. Tanaka, None; H. Shimada, None; R. Mori, None; H. Nakashizuka, None; T. Hattori, None; Y. Okubo, None.

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Corresponding author: Hiroyuki Shimada

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Tanaka, K., Shimada, H., Mori, R. et al. No increase in incidence of post-intravitreal injection endophthalmitis without topical antibiotics: a prospective study. Jpn J Ophthalmol 63, 396–401 (2019). https://doi.org/10.1007/s10384-019-00684-5

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  • DOI: https://doi.org/10.1007/s10384-019-00684-5

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