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Guidelines for preventing infection from intravitreal injections continue to evolve
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WAIKOLOA, Hawaii — As more indications for anti-VEGF therapy are established and more products become available, guidelines for how to administer an intravitreal injection continue to evolve, Sophie J. Bakri, MD, told colleagues at Retina 2019.
“The main purpose of these [guidelines] is to prevent the serious complication of infectious endophthalmitis,” she said.
Among changes of note over the years, Bakri said it is no longer necessary to dilate the pupil, but rather the practice is optional. Draping is unnecessary, as is the use of gloves, whether they are sterile or not.
“But I really do believe the patients expect to see the proceduralist coming toward them with a pair of gloves on,” she said.
A “no-talk” technique minimizes contamination with patient or physician oropharyngeal flora.
“The consensus recommendation now is that we minimize talking in the room, or we put the mask on,” she said.
Studies support the finding that antibiotic drops before and after the procedure do not reduce the already low rate of endophthalmitis and may be associated with a higher incidence of infection.
“One of the things we worry about is that using prophylactic antibiotics may actually promote microbial resistance,” she said.
Aqueous chlorhexidine can be used as an alternative to iodine in patients who report an iodine allergy.
“Povidone-iodine allergy is extremely rare,” she said, adding that seafood allergy is not related to iodine content. – by Patricia Nale, ELS
Reference: Bakri SJ. Guidelines for the administration of intravitreal injections. Presented at: Retina 2019; Jan. 20-25, 2019; Waikoloa, Hawaii.
Disclosures: Bakri reports she is a consultant for Allegro Ophthalmics, Allergan, Alimera, EyePoint, Novartis and Zeiss, and receives research funding from the National Eye Institute and Lowy Medical Foundation.