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Topical antibiotic prophylaxis before intravitreal injections: a pilot study

  • Medical Ophthalmology
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Abstract

Purpose

To explore whether topical antibiotic prophylaxis in patients scheduled for intravitreal injections achieves surface sterility in a greater proportion of subjects as compared to povidone-iodine alone.

Material and methods

A randomized, triple-blind clinical trial. Population: patients scheduled for intravitreal injections for maculopathy. Inclusion criteria: any sex and race, age 18 years and above. Subjects were randomized into 4 groups: the first group applied chloramphenicol (CHLORAM), the second netilmicin (NETILM), the third a commercial ozonized antiseptic solution (OZONE), and the fourth applied no drops (CONTROL). Outcome variable: percentage of non-sterile conjunctival swabs. Specimens were collected before and after the application of 5% povidone-iodine moments before the injection.

Results

Ninety-eight subjects (33.7% females, 64.3% males), mean age: 70.2 ± 9.3 years (54–91). Before povidone-iodine, both the CHLORAM and NETILM group showed a lower percentage of non-sterile swabs (61.1% and 31.3% respectively), as compared to the OZONE (83.3%) and CONTROL (86.5%) groups (p < .04). However, this statistical difference was lost after the application of povidone-iodine for 3 min. Percentage of non-sterile swabs in each group after applying 5% povidone-iodine: CHLORAM 11.1%, NETILM 12.5%, CONTROL 15.4%, OZONE 25.0%. This was not statistically significant (p > .05).

Conclusions

Topical antibiotic prophylaxis with chloramphenicol or netilmicin drops decreases the bacterial load on the conjunctiva. However, after the application of povidone-iodine, all groups showed a significant reduction in the percentage of non-sterile swabs, and this value was comparable among all groups. For this reason, authors conclude that povidone-iodine alone is sufficient and prior topical antibiotic prophylaxis is not indicated.

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Change history

  • 28 June 2023

    The given name and family name of the first author has been incorrectly identified in the XML version. This has been updated and corrected: "Edoardo" as given name and "Trovato Battagliola" as family name.

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Author information

Authors and Affiliations

  1. Department of Sense Organs, Sapienza” University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy

    Edoardo Trovato Battagliola, Gregorio Manco, Claudio Brancato, Pietro Mangiantini, Floriana Testa, Mariaelena Malvasi, Fernanda Pacella & Elena Pacella

  2. Department of Diagnostic Medicine and Radiology, UOC Microbiology and Virology, Azienda Policlinico Umberto I, Rome, Italy

    Rodolfo Javier Riveros Cabral & Gianluca Puggioni

  3. Department of Public Health and Infectious Diseases, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, Rome, Italy

    Giammarco Raponi

  4. National Institute for Health Migration and Poverty, Rome, Italy

    Paolo Turchetti

Authors
  1. Edoardo Trovato Battagliola
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Contributions

Edoardo, Trovato Battagliola, MD: Writing—original draft.

Rodolfo Javier, Riveros Cabral, MD: Data curation.

Gregorio Manco, MD: Project administration.

Gianluca Puggioni: Investigation, data curation.

Claudio Brancato, MD: Investigation, data curation.

Pietro Mangiantini, MD: Formal analysis.

Floriana Testa, MD: Visualization.

Mariaelena Malvasi, MD: Visualization.

Giammarco Raponi, MD: Supervision.

Paolo Turchetti, MD: Methodology.

Fernanda Pacella, MD. Methodology.

Elena Pacella, MD: Conceptualization, writing—review and editing, supervision.

Corresponding author

Correspondence to Elena Pacella.

Ethics declarations

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Sapienza University of Rome (Nov. 8th, 2021/No. 345235).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

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Trovato Battagliola, E., Riveros Cabral, R.J., Manco, G. et al. Topical antibiotic prophylaxis before intravitreal injections: a pilot study. Graefes Arch Clin Exp Ophthalmol 261, 2953–2959 (2023). https://doi.org/10.1007/s00417-023-06113-1

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