Malpractice fears may drive use of antibiotic drops after intravitreal injections in some countries

PARIS — A round table held during the meeting of the French Society of Ophthalmology highlighted that topical antibiotics have not been discontinued during intravitreal injection procedures in all countries.

While no antibiotics are used in France, the U.K. and Germany, exceptions are made in Spain for Ozurdex (dexamethasone intravitreal implant, Allergan) and for injections performed in patients with diabetes. In Italy, according to Domenico Boccuzzi, MD, postoperative antibiotic drops are still administered four times a day for 1 week after all intravitreal procedures by the majority of ophthalmologists.

“There is now quite a lot of evidence showing that the use of topical antibiotics during, before or after the procedure offers no extra protection and should mandatorily be avoided,” Isabelle Cochereau, MD, moderator of the round table, said.

Isabelle Cochereau

Serial intravitreal injections in a large number of people greatly increase antibiotic resistance. Should endophthalmitis occur, it would be less likely to respond to treatment. In addition, due to the modified ocular surface flora, the risk of antibiotic-resistant endophthalmitis would be greatly increased in case of a future cataract surgery procedure. Finally, antibiotic-resistant organisms migrate from the surface of the eye to the nose, the digestive tract and out in the environment.

“Antibiotic resistance is a global ecological problem,” Cochereau said.

Antibiotic prophylaxis was included in the dossier for the approval of intravitreal procedures, but following several scientific studies, consensus was gained against its use.

Yet, antibiotic prophylaxis, or the lack of it, is still a strong argument in case of legal litigation, Boccuzzi said.

“Italian ophthalmologists use antibiotics because they are afraid of lawsuits,” he said.

The panel advocated the need for official international guidelines to protect ophthalmologists against malpractice allegations. – by Michela Cimberle

Reference:

Cochereau I, et al. Round table. Presented at: French Society of Ophthalmology meeting; May 7-10, 2016; Paris.

Disclosure s : Boccuzzi reports no relevant financial disclosures. Cochereau reports she is a consultant to Théa.