Summary
BACKGROUND: Intravitreal injection of vascular endothelial growth factor inhibitors is safe as a standardized procedure. In a retrospective study, we examined the incidence of intraocular inflammation and endophthalmitis when intravitreal Avastin was given on both an outpatient and an inpatient basis. METHODS AND PATIENTS: Two centers treated a total of 1844 patients with intravitreal Avastin injection (IVA), 1.25 mg/0.05 ml. The medication was given under aseptic conditions with a sterile drape and lid speculum and after an incubation of 5% povidone-iodine for 60 s in the conjunctival fornix. Center A performed all applications as an outpatient procedure with no postoperative topical antibiotics. Center B performed all IVAs prior to a 1-day hospital admission and gave topical antibiotics for 3 days. In both centers the patients were told to return to the hospital immediately if visual disturbance, pain, or redness of the eyes was noticed. RESULTS: Center A did 984 IVAs. Postoperatively no patients had endophthalmitis. On the 2nd postoperative day, two patients developed a mild intraocular uveitis, which was treated with local steroid ointments. Center B did 860 IVAs. Five days after discharge from the hospital, two patients presented with endophthalmitis and underwent vitrectomy when their vision dropped to counting fingers. There was no positive microbiological result of either vitreous probe. CONCLUSIONS: Although equal treatment guidelines were established, the perioperative hospital admission and post-operative application of topical antibiotic ointment could not reduce the occurrence of mild to severe intraocular endophthalmitis.
Zusammenfassung
HINTERGRUND: Die intravitreale Injektion von Vascular-endothelial-growth-factor- (VEGF-) Hemmern ist bei sachgemäßer Anwendung eine sichere Prozedur. In einer retrospektiven Studie untersuchten wir die Häufigkeit von intraokularen Reizzuständen und Endophthalmitiden nach ambulanter und stationärer Betreuung. METHODEN UND PATIENTEN: An zwei Zentren behandelten wir 1844 Patienten mit intravitrealen Avastin-Injektionen (IVA) 1,25 mg/0,05 ml. Die Injektion wurde unter aseptischen Bedingungen mit sterilem Abdecktuch, Lidspekulum und nach 60 s Einwirken von 5% Povidon-Jod im konjunktivalen Fornix durchgeführt. An Zentrum A erfolgten alle Eingriffe als ambulante Leistung, und postoperativ wurde keine topische Antibiose gegeben. An Zentrum B erfolgte die IVA vor eintägiger stationärer Aufnahme und die Patienten erhielten für 3 Tage antibiotische Augentropfen. An beiden Zentren wurden die Patienten angehalten, sich bei unklaren Sehbeschwerden, Rötung oder Schmerzen am Auge unverzüglich in der Augenklinik zu melden. ERGEBNISSE: An Zentrum A erhielten 984 Patienten eine IVA, postoperativ wurde keine Endophthalmitis beobachtet, bei 2 Patienten trat am 2. postoperativen Tag ein milder intraokularer Reiz auf, der mit lokalen steroidalen Augentropfen behandelt wurde. An Zentrum B erfolgten 860 IVA, und es traten 5 Tage nach Entlassung 2 Endophthalmitiden auf, die nach Visusabfall auf Handbewegung vitrektomiert wurden. Postoperativ konnte mikrobiologisch aus der Glaskörperprobe allerdings kein Erreger festgestellt werden. SCHLUSSFOLGERUNG: Trotz gleicher Behandlungsrichtlinien konnte eine perioperative stationäre Betreuung und post-operative Gabe von topischen Augentropfen die Anzahl an leichten und schweren intraokularen Reizzuständen nicht reduziert werden.
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Meyer, C., Mennel, S., Eter, N. et al. Endophthalmitisrate mit und ohne topische post-operative Antibiotikagabe nach intravitrealer Avastin-Injektion. Spektrum Augenheilkd. 22, 14–18 (2008). https://doi.org/10.1007/s00717-008-0238-0
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DOI: https://doi.org/10.1007/s00717-008-0238-0
Key words
- Intraocular inflammation
- Vascular endothelial growth factor inhibitors
- Endophthalmitis
- Intravitreal injection
- Antibiotics