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Rate of endophthalmitis after intravitreal injection low without topical antibiotics

Arch Ophthalmol. 2009;127(12):1581-1583.

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Endophthalmitis after intravitreal drug injection can be reduced with a standardized protocol that does not require the use of topical antibiotics, sterile gloves or a sterile drape, according to a study.

"The results herein indicate that a low rate of endophthalmitis can be achieved by means of an intravitreal injection protocol that includes the use of topical povidone-iodine, a lid speculum and topical anesthetic," the study authors said. "However, achievement of that rate does not require topical antibiotic prophylaxis before, the day of or the day after the injection."

The study data from two large, multicenter, prospective randomized clinical trials included 3,226 intravitreal injections of Lucentis (ranibizumab, Genentech) in 461 eyes and 612 injections of preservative-free triamcinolone in 272 eyes.

Topical antibiotics were administered on the day of injection in 361 cases, for several days after injection in 813 cases, on the day of injection and after injection in 1,388 cases, and neither on the day of injection nor after injection in 1,276 cases.

Study data showed three cases of culture-positive endophthalmitis among the 3,226 ranibizumab injections. Antibiotics were not administered before injection but were given for several days after injection in all three cases. Cultures showed major growth of Streptococcus viridans and minimal growth of Staphylococcus aureus in one case and coagulase-negative Staphylococcus in two cases.

Results showed no cases of culture-positive endophthalmitis among the 612 triamcinolone injections, the authors said.

"However, because of the low incidence of endophthalmitis, no study can rule out the possibility that topical antibiotics might have a minor effect on the risk of endophthalmitis," they said. "Therefore, the results of this study do not prove that topical antibiotics have no effect on the risk of endophthalmitis after intravitreal injection."