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Intravitreal Injections: Guidelines to Minimize the Risk of Endophthalmitis

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Retinal Vascular Disease

Abstract

Intravitreal injection was reported by Ohm in 1911 as a technique to introduce air for retinal tamponade and repair of retinal detachment [28]. Intravitreal administration of pharmacotherapies dates to the mid-1940s with the use of penicillin to treat endophthalmitis [34, 35]. Since that time, use of the intravitreal injection technique has steadily increased, with its usage being focused primarily on the treatment of retinal detachment [7, 32], endophthalmitis [8, 31], and cytomegalovirus (CMV) retinitis [13, 43]. The increasing confidence in the efficacy and safety of intravitreal injections, in conjunction with the development of additional pharmacotherapies, has led to a recent rapid increase in the use of this technique for the administration of various pharmacotherapies (e.g., ranibizumab [6], pegaptanib sodium [9, 41, 42]) for age-related macular degeneration (AMD) and intravitreal triamcinolone for macular edema associated with a variety of etiologies, such as diabetic retinopathy [21], central retinal vein occlusion [10, 36], branch retinal vein occlusion [5, 17, 30, 37], uveitis [2, 44], and birdshot retinochoroidopathy [22].

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References

  1. Aiello LP, Brucker AJ, Chang S, et al. (2004) Evolving guidelines for intravitreous injections. Retina 24:S3–S19

    Article  PubMed  Google Scholar 

  2. Antcliff RJ, Spalton DJ, Stanford MR, et al. (2001) Intravitreal triamcinolone for uveitic cystoid macular edema: an optical coherence tomography study. Ophthalmology 108: 765–772

    Article  PubMed  CAS  Google Scholar 

  3. Bannerman TL, Rhoden DL, McAllister SK, et al. (1997) The source of coagulase-negative staphylococci in the Endophthalmitis Vitrectomy Study. A comparison of eyelid and intraocular isolates using pulsed-field gel electrophoresis. Arch Ophthalmol 115:357–361

    PubMed  CAS  Google Scholar 

  4. Bucci FA, Amico LM, Guerino A, Evans R (2003) The effect of preop lid scrubs and levofloxacin on eyelid and conjunctival cultures prior to cataract surgery. Association for Research in Vision and Ophthalmology, Fort Lauderdale, FL

    Google Scholar 

  5. Cekic O, Change S, Tseng JJ, et al. (2005) Intravitreal triamcinolone injection for treatment of macular edema secondary to branch retinal vein occlusion. Retina 25:851–855

    Article  PubMed  Google Scholar 

  6. Chang TS, Tonnu IQ, Globe DR, Fine J (2004) Longitudinal changes in self-reported visual functioning in AMD patients in a randomized controlled phase I/II trial of Lucentis (ranibizumab; rHuFAV v2). Invest Ophthal Vis Sci 45:E-Abstract 3098

    Google Scholar 

  7. Cibis PA, Becker B, Okun E, Canaan S (1962) The use of liquid silicone in retinal detachment surgery. Arch Ophthalmol 68:590–599

    PubMed  CAS  Google Scholar 

  8. Forster RK, Zachary IG, Cottingham AJ Jr, Norton EWD (1976) Further observations on the diagnosis, cause, and treatment of endophthalmitis. Am J Ophthalm 81:52–56

    CAS  Google Scholar 

  9. Gragoudas ES, et al., for the VEGF Inhibition Study inOcular Neovascularization Clinical Trial Group (2004) Pegaptanib for neovascular age-related macular degeneration. N Engl J Med 351:2805–2816

    Article  PubMed  CAS  Google Scholar 

  10. Greenberg PB, Martidis A, Rogers AH, et al. (2002) Intravitreal triamcinolone acetonide for macular oedema due to central retinal vein occlusion. Br J Ophthalmol 86:247–248

    Article  PubMed  Google Scholar 

  11. Grimes S, Mein C, Trevino S (1991) Preoperative antibiotic and povidone-iodine preparation of the eye. Ann Ophthalmol 23:263–266

    PubMed  CAS  Google Scholar 

  12. Han DP, Wisniewski SR, Wilson LA, et al. (1996) Spectrum and susceptibilities of microbiologic isolates in the Endophthalmitis Vitrectomy Study. Am J Ophthalmol 122:1–17

    PubMed  CAS  Google Scholar 

  13. Henry K, Cantrill H, Fletcher C, et al. (1987) Use of intravitreal ganciclovir (dihydroxy propoxymethyl guanine) for cytomegalovirus retinitis in a patient with AIDS. Am J Ophthalmol 103:17–23

    PubMed  CAS  Google Scholar 

  14. Hovding G, Sjursen H (1982) Bacterial contamination of drops and dropper tips of in-use multidose eye drop bottles. Acta Ophthalmol (Copenh) 60:213–222

    Article  CAS  Google Scholar 

  15. Isenberg S, Apt L, Yoshimori R, Khwarg S (1985) Chemical preparation of the eye in ophthalmic surgery IV: comparison of povidone-iodine on the conjunctiva with a prophylactic antibiotic. Arch Ophthalmol 103:1340–1342

    PubMed  CAS  Google Scholar 

  16. Jager RD, Aiello LP, Patel SC, et al. (2004) Risks of intravitreous injection: a comprehensive review. Retina 24:676–698

    Article  PubMed  Google Scholar 

  17. Jonas JB, Akkoyun I, Kamppeter B, et al. (2005) Branch retinal vein occlusion treated by intravitreal triamcinolone acetonide. Eye 19:65–71

    Article  PubMed  CAS  Google Scholar 

  18. Jonas JB, Kreissig I, Degenring RF (2003) Endophthalmitis after intravitreal injection of triamcinolone acetonide. Arch Ophthalmol 121:1663–1664

    Article  PubMed  Google Scholar 

  19. Kozak I, Cheng L, Freeman WR (2005) Lidocaine gel anesthesia for intravitreal drug administration. Retina 25:994–998

    Article  PubMed  Google Scholar 

  20. Leong JK, Shah R, McCluskey PJ, et al. (2002) Bacterial contamination of the anterior chamber during phacoemulsification cataract surgery. J Cataract Refract Surg 28:826–833

    Article  PubMed  Google Scholar 

  21. Martidis A, Duker JS, Greenberg PB, et al. (2002) Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology 109:920–927

    Article  PubMed  Google Scholar 

  22. Martidis A, Duker JS, Puliafito CA (2001) Intravitreal triamcinolone for refractory cystoid macular edema secondary to birdshot retinochoroidopathy. Arch Ophthalmol 119:1380–1383

    PubMed  CAS  Google Scholar 

  23. Miller JJ, Scott IU, Flynn HW Jr, et al. (2005) Acute-onset endophthalmitis after cataract surgery (2000–2004): incidence, clinical settings, and visual acuity outcomes after treatment. Am J Ophthalmol 139:983–987

    Article  PubMed  Google Scholar 

  24. Moshfeghi AA, Scott IU, Flynn HW Jr, Puliafito CA (2004) Pseudohypopyon after intravitreal triamcinolone acetonide injection for cystoid macular edema. Am J Ophthalmol 138:489–492

    Article  PubMed  CAS  Google Scholar 

  25. Moshfeghi DM, Kaiser PK, Bakri SJ, Kaiser RS, Maturi RK, Sears JE, Scott IU, Belmont J, Beer PM, Quiroz-Mercado H, Mieler WF (2005) Presumed sterile endophthalmitis following intravitreal triamcinolone acetonide injection. Ophthalmic Surg Lasers Imaging 36:24–29

    PubMed  Google Scholar 

  26. Moshfeghi DM, Kaiser PK, Scott IU, Sears JE, Benz M, Sinesterra JP, Kaiser RS, Bakri SJ, Maturi RK, Belmont J, Beer PM, Murray TG, Quiroz-Mercado H, Mieler WF (2003) Acute endophthalmitis following intravitreal triamcinolone acetonide injection. Am J Ophthalmol 136:791–796

    Article  PubMed  CAS  Google Scholar 

  27. Nelson ML, Tennant MT, Sivalingam A, et al. (2003) Infectious and presumed noninfectious endophthalmitis after intravitreal triamcinolone acetonide injection. Retina 23: 686–691

    Article  PubMed  Google Scholar 

  28. Ohm J (1911) Über die Behandlung der Netzhautablösung durch operative Entleerung der Subretinalen Flössigkeit und Einspritzung von Luft in den Glaskörper. Albrecht von Graefes Arch Ophthalmol 79:442–450

    Google Scholar 

  29. Osher RH, Amdahl LD, Cheetham JK (1994) Antimicrobial efficacy and aqueous humor concentration of preoperative and postoperative topical trimethoprim/polymyxin B sulfate versus tobramycin. J Cataract Refract Surg 20:3–8

    PubMed  CAS  Google Scholar 

  30. Ozkiris A, Evereklioglu C, Erkilic K, Ilhan O(2005) The efficacy of intravitreal triamcinolone acetonide on macular edema in branch retinal vein occlusion. Eur J Ophthalmol 15:96–101

    PubMed  CAS  Google Scholar 

  31. Peyman GA, Vastine DW, Raichand M(1978) Experimental aspects and their clinical application. Ophthalmology 85:374–385

    PubMed  CAS  Google Scholar 

  32. Rosengren B (1952) 300 cases operated upon for retinal detachment; method and results. Acta Ophthalmol (Copenh) 30:117–122

    CAS  Google Scholar 

  33. Roth DB, Chieh J, Spirn MJ, et al. (2003) Non-infectious endophthalmitis associated with intravitreal triamcinolone injection. Arch Ophthalmol 121:1279–1282

    Article  PubMed  Google Scholar 

  34. Rycroft B (1945) Penicillin and the control of deep intraocular infection. Br J Ophthalmol 29:57–87

    Article  PubMed  CAS  Google Scholar 

  35. Schneider J, Frankel SS (1947) Treatment of late postoperative intraocular infections with intraocular injection of penicillin. Arch Ophthalmol 37:304–307

    Google Scholar 

  36. Scott IU, Ip MS (2005) It’s time for a clinical trial to investigate intravitreal triamcinolone for macular edema associated with retinal vein occlusion: the SCORE study. Arch Ophthalmol 123:581–582

    Article  PubMed  Google Scholar 

  37. Speaker MG, Menikoff JA (1991) Prophylaxis of endophthalmitis with topical povidone-iodine. Ophthalmology 98:1769–1775

    PubMed  CAS  Google Scholar 

  38. Speaker MG, Milch FA, Shah MK, et al. (1991) Role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis. Ophthalmology 98:639–649; discussion 650

    PubMed  CAS  Google Scholar 

  39. Sutter FK, Gillies MC (2003) Pseudo-endophthalmitis after intravitreal injection of triamcinolone. Br J Ophthalmol 87:972–974

    Article  PubMed  CAS  Google Scholar 

  40. Ta CN, Egbert PR, Singh K, et al. (2002) Prospective randomized comparison of 3-day versus 1-hour preoperative ofloxacin prophylaxis for cataract surgery. Ophthalmology 109:2036–2041

    Article  PubMed  Google Scholar 

  41. The Eyetech Study Group (2002) Preclinical and phase 1A clinical evaluation of an anti-VEGF pegylated aptamer (EYE001) for the treatment of exudative age-related macular degeneration. Retina 22:143–152

    Article  Google Scholar 

  42. The Eyetech Study Group (2003) Anti-vascular endothelial growth factor therapy for subfoveal choroidal neovascularization secondary to age-related macular degeneration: phase II study results. Ophthalmology 110:979–986

    Article  Google Scholar 

  43. Vitravene injection (fomivirsen sodium intravitreal injectable). Approval letter, pages 1–4. Vol 2004. U.S. Food and Drug Adminstration website. Available at: http://www.fda.gov/cder/foi/nda/98/20961_Vitravene_Approv.pdf. Accessed April 29, 2004

  44. Young S, Larkin G, Branley M, Lightman S (2001) Safety and efficacy of intravitreal triamcinolone for cystoid macular oedema in uveitis. Clin Exp Ophthalmol 29:2–6

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, Penn State College of Medicine, 500 University Drive, HU19, Hershey, PA, 17033-0850, USA

    Ingrid U. Scott MD, MPH

  2. Bascom Palmer Eye Institute, 900 N.W. 17th Street, Miami, FL, 33136, USA

    Harry W. Flynn Jr MD

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  1. Ingrid U. Scott MD, MPH
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  2. Harry W. Flynn Jr MD
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Editor information

Editors and Affiliations

  1. Department of Ophthalmology, University of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany

    Antonia M. Joussen MD, PhD (Professor of Ophthalmology) (Professor of Ophthalmology)

  2. Department of Ophthalmology, Penn State College of Medicine, 500 University, Drive Box 850, Hershey, PA, 17033, USA

    Thomas W. Gardner MD, MS (Professor of Ophthalmology) (Professor of Ophthalmology)

  3. Department of Vitreoretinal Surgery, Center for Ophthalmology, University of Cologne, Joseph-Stelzmann-Straße 9, 50931, Cologne, Germany

    Bernd Kirchhof MD (Professor of Ophthalmology) (Professor of Ophthalmology)

  4. Doheny Eye Institute, University of Southern California, 1450 San Pablo Street, Los Angeles, CA, 90033, USA

    Stephen J. Ryan MD (Professor of Ophthalmology) (Professor of Ophthalmology)

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© 2007 Springer-Verlag Berlin Heidelberg

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Scott, I.U., Flynn, H.W. (2007). Intravitreal Injections: Guidelines to Minimize the Risk of Endophthalmitis. In: Joussen, A.M., Gardner, T.W., Kirchhof, B., Ryan, S.J. (eds) Retinal Vascular Disease. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-29542-6_18

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  • DOI: https://doi.org/10.1007/978-3-540-29542-6_18

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-29541-9

  • Online ISBN: 978-3-540-29542-6

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