Retina specialists could have more options for pre-injection disinfection
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FORT LAUDERDALE, Fla. — Chlorhexidine and hypochlorous acid could be viable alternatives for disinfection before intravitreal injections, according to a presenter at the Retina World Congress.
Robert L. Avery, MD, said povidone-iodine reduces the risk for endophthalmitis and remains the gold standard for disinfection.
“However, it does cause significant pain in a handful, if not a large number, of patients, at least in my practice,” he said. “It’s probably responsible not only for those after-hours calls, but in some patients, noncompliance with therapy. They sort of dread the pain afterward.”
In reviewing several potential options, Avery identified chlorhexidine and hypochlorous acid as alternatives to povidone-iodine.
Avery said previous studies have showed that chlorhexidine disinfection led to lower pain scores both immediately after instillation (P < .001) and after 1 day when compared with povidone-iodine. The culture positivity rates before and after disinfection were similar with both agents.
Avery explored hypochlorous acid in a pilot study at his practice comprising 124 eyes. Each patient was undergoing bilateral anti-VEGF injections and received hypochlorous acid in one eye and povidone-iodine in the other. Standardized pain scores were used at instillation, injection and 1 to 2 hours after injection. The hypochlorous acid led to lower pain scores across all time points.
Although povidone-iodine remains his top choice for disinfection, Avery said chlorhexidine and hypochlorous acid could be viable alternatives in certain patients.
“We need to do more, larger studies before we change the standard of care,” he said. “I’m not recommending we adopt it right now, but for those patients that have extreme pain with [povidone-iodine] and refuse it, I certainly think it’s better than nothing. Those patients are very happy to change.”
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Avery RL. Disinfection prior to intravitreal injection: Is povidone-iodine the only option? Presented at: Retina World Congress; May 12-15, 2022; Fort Lauderdale, Fla.
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