Minimizing the endophthalmitis rate following intravitreal injections using 0.25 % povidone–iodine irrigation and surgical mask
- First Online:
- 723 Downloads
To examine the efficacy of complying with an infection control manual for intravitreal injection of anti-vascular endothelial growth factor (VEGF) preparations in reducing the rate of endophthalmitis.
We retrospectively reviewed intravitreal anti-VEGF injections conducted by vitreoretinal specialists at the outpatient injection room of a single university hospital between July 2009 and July 2012. The injections were conducted following an infection control manual established by our department. Doctors and nurses wore surgical masks, and disinfected the patient’s eyelid skin with 10 % povidone–iodine and then the conjunctiva with 0.25 % povidone–iodine. After putting a drape on the patient’s face, a lid speculum was placed. The conjunctival surface was again washed with 5 ml of 0.25 % povidone–iodine. After waiting at least 30 seconds, intravitreal injection was performed through povidone–iodine. Following injection, the injection site was again washed with 5 ml of 0.25 % povidone–iodine. Patients were treated with topical levofloxacin 4 times a day for 3 days before and after the injection.
A total of 15,144 injections comprising 548 injections of pegaptanib sodium, 846 injections of bevacizumab, and 13,750 injections of ranibizumab were performed. During this period, no case of suspected or proven infectious endophthalmitis occurred. The endophthalmitis rate was 0 per 15,144 injections, (95 % confidence interval, 0.0–0.0 %).
The results suggest that endophthalmitis can be reduced to a minimum by preventing normal flora of the conjunctiva and bacteria in the oral cavity from entering the vitreous. For this purpose, an infection control manual that requires nurses and doctors to wear surgical mask and drape the patient’s face, irrigate the conjunctiva with 0.25 % povidone–iodine and wait at least 30 seconds before performing intravitreal injection is useful.
KeywordsBevacizumab Conjunctival flora Endophthalmitis Eye drape Eyelid speculum Face mask Intravitreal injection Oral flora Pegaptanib Povidone–iodine Ranibizumab Vascular endothelial growth factor
- 5.Jaffe GJ, Martin D, Callanan D, Pearson PA, Levy B, Comstock T, Fluocinolone Acetonide Uveitis Study Group (2006) Fluocinolone acetonide implant (Retisert) for noninfectious posterior uveitis: thirty-four-week results of a multicenter randomized clinical study. Ophthalmology 113:1020–1027PubMedCrossRefGoogle Scholar
- 13.Singerman LJ, Masonson H, Patel M, Adamis AP, Buggage R, Cunningham E, Goldbaum M, Katz B, Guyer D (2008) Pegaptanib sodium for neovascular age-related macular degeneration: third-year safety results of the VEGF Inhibition Study in Ocular Neovascularisation (VISION) trial. Br J Ophthalmol 92:1606–1611PubMedCrossRefGoogle Scholar
- 17.Wu L, Martínez-Castellanos MA, Quiroz-Mercado H, Arevalo JF, Berrocal MH, Farah ME, Maia M, Roca JA, Rodriguez FJ, Pan American Collaborative Retina Group (PACORES) (2008) Twelve-month safety of intravitreal injections of bevacizumab (Avastin): results of the Pan-American Collaborative Retina Study Group (PACORES). Graefes Arch Clin Exp Ophthalmol 246:81–87PubMedCrossRefGoogle Scholar
- 23.Bhavsar AR, Googe JM Jr, Stockdale CR, Bressler NM, Brucker AJ, Elman MJ, Glassman AR (2009) Diabetic Retinopathy Clinical Research Network. Risk of endophthalmitis after intravitreal drug injection when topical antibiotics are not required: the diabetic retinopathy clinical research network laser-ranibizumab-triamcinolone clinical trials. Arch Ophthalmol 127:1581–1583PubMedCrossRefGoogle Scholar
- 24.Moshfeghi AA, Rosenfeld PJ, Flynn HW Jr, Schwartz SG, Davis JL, Murray TG, Smiddy WE, Berrocal AM, Dubovy SR, Lee WH, Albini TA, Lalwani GA, Kovach JL, Puliafito CA (2011) Endophthalmitis after intravitreal anti-vascular endothelial growth factor antagonists: a six-year experience at a university referral center. Retina 31:662–668PubMedCrossRefGoogle Scholar
- 25.Inoue M, Kobayakawa S, Sotozono C, Komori H, Tanaka K, Suda Y, Matsushima H, Kinoshita S, Senoo T, Tochikubo T, Kadonosono K (2011) Evaluation of the incidence of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor. Ophthalmologica 226:145–150PubMedCrossRefGoogle Scholar
- 26.Shah CP, Garg SJ, Vander JF, Brown GC, Kaiser RS, Haller JA, Post-Injection Endophthalmitis (PIE) Study Team (2011) Outcomes and risk factors associated with endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents. Ophthalmology 118:2028–2034PubMedCrossRefGoogle Scholar