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Novack GD. Infections from Over-the-Counter Artificial Tears: Implications for Patients and Clinicians. Ophthalmology 2023; 130:1114-1117. [PMID: 37865500 DOI: 10.1016/j.ophtha.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/25/2023] [Accepted: 08/09/2023] [Indexed: 10/23/2023] Open
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Baudin F, Benzenine E, Mariet AS, Ghezala IB, Bron AM, Daien V, Gabrielle PH, Quantin C, Creuzot-Garcher C. Topical Antibiotic Prophylaxis and Intravitreal Injections: Impact on the Incidence of Acute Endophthalmitis-A Nationwide Study in France from 2009 to 2018. Pharmaceutics 2022; 14:pharmaceutics14102133. [PMID: 36297568 PMCID: PMC9611403 DOI: 10.3390/pharmaceutics14102133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Background: The dramatic increase in intravitreal injections (IVTs) has been accompanied by a greater need for safer procedures. The ongoing debate about topical antibiotic prophylaxis after IVTs emphasizes the importance of large-scale studies. We aimed to study the role of topical antibiotic prophylaxis in reducing the risk of acute endophthalmitis after IVTs. Methods: Population-based cohort study, in France, from 2009 to 2018, including all French patients receiving IVTs of corticosteroids or anti-VEGF agents. Results: A total of 5,291,420 IVTs were performed on 605,434 patients. The rate of topical antibiotic prophylaxis after IVTs progressively decreased during the study period, with a sharp drop in 2014 (from 84.6% in 2009 to 27.4% in 2018). Acute endophthalmitis occurred in 1274 cases (incidence rate = 0.0241%). Although antibiotic prophylaxis did not alter the risk of endophthalmitis (p = 0.06), univariate analysis showed an increased risk after fluoroquinolone and aminoglycoside prophylaxis. This increased risk was not found in multivariate analysis. However, we observed an increased risk related to the use of fixed combinations of fluoroquinolones and aminoglycosides with corticosteroids (IRR = 1.89; 95% CI = 1.57–2.27%, antibiotics combined with corticosteroids). Conclusion: These results are consistent with the literature. Endophthalmitis rates after IVTs did not decrease with topical antibiotic prophylaxis. The use of a combination of antibiotics and corticosteroids doubles the risk of endophthalmitis and should be avoided. Avoiding antibiotic prophylaxis would reduce the costs and the potential risks of antibiotic resistance.
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Affiliation(s)
- Florian Baudin
- Department of Ophthalmology, University Hospital, 21000 Dijon, France
- EA7460, PEC2, Cerebral and Cardiovascular Epidemiology, and Physiopathology, 21000 Dijon, France
| | - Eric Benzenine
- Biostatistics and Bioinformatics (DIM), University Hospital, 21079 Dijon, France
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, BP 77908, 21079 Dijon, France
| | - Anne-Sophie Mariet
- Biostatistics and Bioinformatics (DIM), University Hospital, 21079 Dijon, France
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, BP 77908, 21079 Dijon, France
- INSERM, CIC 1432, 21000 Dijon, France
- Clinical Epidemiology, Clinical Trials Unit, Clinical Investigation Center, Dijon University Hospital, 21000 Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, 94807 Paris, France
| | - Inès Ben Ghezala
- Department of Ophthalmology, University Hospital, 21000 Dijon, France
- EA7460, PEC2, Cerebral and Cardiovascular Epidemiology, and Physiopathology, 21000 Dijon, France
| | - Alain M. Bron
- Department of Ophthalmology, University Hospital, 21000 Dijon, France
- Eye and Nutrition Research Group, Bourgogne Franche-Comté University, 21000 Dijon, France
| | - Vincent Daien
- Department of Ophthalmology, University Hospital, 34295 Montpellier, France
- Inserm U1061, University of Montpellier, 34000 Montpellier, France
| | - Pierre-Henry Gabrielle
- Department of Ophthalmology, University Hospital, 21000 Dijon, France
- Eye and Nutrition Research Group, Bourgogne Franche-Comté University, 21000 Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, 21079 Dijon, France
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, BP 77908, 21079 Dijon, France
- INSERM, CIC 1432, 21000 Dijon, France
- Clinical Epidemiology, Clinical Trials Unit, Clinical Investigation Center, Dijon University Hospital, 21000 Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, 94807 Paris, France
| | - Catherine Creuzot-Garcher
- Department of Ophthalmology, University Hospital, 21000 Dijon, France
- Eye and Nutrition Research Group, Bourgogne Franche-Comté University, 21000 Dijon, France
- Correspondence: ; Tel.: +33-(0)-380293277
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Emerson GG, Rahman MM, Kim DH, Stein JD, VanderBeek BL. Board Certification Is Associated With a Reduced Risk of Endophthalmitis After Intravitreal Injections. JOURNAL OF VITREORETINAL DISEASES 2022; 6:116-121. [PMID: 37008659 PMCID: PMC9976016 DOI: 10.1177/24741264211028519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work investigates associations between physician qualifications and the risk of postintravitreal injection endophthalmitis. Methods: This retrospective analysis of data from medical claims studied Medicare beneficiaries undergoing 1 or more intravitreal injections between January 1, 2013, and December 31, 2017. Logistic regression analysis was performed to assess whether board certification status or retina subspecialty training was associated with lower risk of postinjection endophthalmitis, controlling for patient's age, race, and sex, type of agent injected, diagnosis, and year of injection. The main outcome measure was odds ratio (OR) of receiving a diagnosis of endophthalmitis in the 14 days after intravitreal injection. Clinical outcome and quality of care were not evaluated in this study. Results: A total of 2 907 324 intravitreal injections were performed on 219 640 patients by 4315 ophthalmologists, 3196 (74%) of whom were retina specialists and 4021 (92%) of whom were certified by the American Board of Ophthalmology (ABO). Overall, there were 1088 (0.037%) cases of postinjection endophthalmitis, of which 1024 (0.037%) were injected by ABO-certified ophthalmologists and 64 (0.050%) by non–board-certified ophthalmologists. Injections by ABO-certified ophthalmologist had 28% reduced odds of endophthalmitis (OR = 0.72; 95% CI, 0.523-0.996, P = .05). Higher odds of endophthalmitis were observed for corticosteroid injections (OR = 3.91; 95% CI, 2.75-5.56, P < .001) and aflibercept injections (OR = 1.47; 95% CI, 1.19-1.80, P < .001). Patients' sex and race, the diagnosis associated with the injection, and providers' retina subspeciality training were not associated with the rate of endophthalmitis ( P < .20 for all comparisons). Conclusions: We found evidence that endophthalmitis may be reduced when ABO-certified physicians perform an intravitreal injection.
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Affiliation(s)
| | - Moshiur M. Rahman
- W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Diana H. Kim
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua D. Stein
- W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
- Center for Eye Policy and Innovation, Ann Arbor, MI, USA
- University of Michigan School of Public Health, Ann Arbor, MI, USA
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Lam LA, Mehta S, Lad EM, Emerson GG, Jumper JM, Awh CC. Intravitreal Injection Therapy: Current Techniques and Supplemental Services. JOURNAL OF VITREORETINAL DISEASES 2021; 5:438-447. [PMID: 37008713 PMCID: PMC9976140 DOI: 10.1177/24741264211028441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: Intravitreal injection is the most frequently performed eye procedure in the world and is an essential component in the management of sight-threating retinal diseases and conditions. Given the seriousness and range of diseases treated and the risks of the procedure, retina specialists must weigh the pros and cons of each individual treatment. Complexities guiding injection treatment are multifaceted and involve patient-history review, careful examination, diagnostic testing selection and interpretation, customized medical decision-making, and follow-up considerations. Methods: This article by the Intravitreal Injection Task Force Committee of the American Society of Retina Specialists documents the intricacies and necessary components of the intravitreal injection procedure. Results: By expert consensus, the task force further recommends ancillary services and decision-making that may accompany intravitreal injection visits, when appropriate, to monitor response to treatment, adjust treatment, and manage additional considerations in the same or fellow eye. Conclusions: Retina specialists can optimize safety and therapeutic outcomes with individualized consideration and customization of intravitreal injection treatment for each patient.
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Affiliation(s)
- Linda A. Lam
- University of Southern California Roski Eye Institute, Keck School of Medicine, Los Angeles, CA, USA
| | - Sonia Mehta
- Wills Eye Hospital/Mid-Atlantic Retina, Philadelphia, PA, USA
| | - Eleonora M. Lad
- Duke Eye Center, Duke University Medical School, Durham, NC, USA
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Novack GD, Moshiri A. Off-Label Use as a Standard of Care. Am J Ophthalmol 2021; 224:A6-A8. [PMID: 33068530 DOI: 10.1016/j.ajo.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Gary D Novack
- Department of Ophthalmology & Visual Sciences, University of California, Davis, Davis, California, USA; PharmaLogic Development, Inc, San Rafael, California, USA.
| | - Ala Moshiri
- Department of Ophthalmology & Visual Sciences, University of California, Davis, Davis, California, USA
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Melo GB, Cruz NFSD, Emerson GG, Rezende FA, Meyer CH, Uchiyama S, Carpenter J, Shiroma HF, Farah ME, Maia M, Rodrigues EB. Critical analysis of techniques and materials used in devices, syringes, and needles used for intravitreal injections. Prog Retin Eye Res 2020; 80:100862. [PMID: 32311476 DOI: 10.1016/j.preteyeres.2020.100862] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/23/2020] [Accepted: 04/02/2020] [Indexed: 12/26/2022]
Abstract
Intravitreal injections have become the most commonly performed intraocular treatments worldwide. Because intravitreal injections may induce severe adverse events, such as infectious and noninfectious endophthalmitis, cataract, ocular hypertension, vitreous hemorrhage, or retinal detachment, appropriate awareness of the materials and techniques used are essential to reduce these sight-threatening complications. This review provides insights into the needles, syringes, silicone oil coating, sterilization methods, devices to assist intravitreal injections, scleral piercing techniques using needles, syringe handling, anesthesia, and safety issues related to materials and techniques. It is paramount that physicians be aware of every step involved in intravitreal injections and consider the roles and implications of all materials and techniques used. The ability to understand the theoretical and practical circumstances may definitely lead to state-of-the-art treatments delivered to patients. The most important practical recommendations are: choosing syringes with as little silicone oil as possible, or, preferably, none; avoiding agitation of syringes; awareness that most biologics (e.g., antiangiogenic proteins) are susceptible to changes in molecular properties under some conditions, such as agitation and temperature variation; understanding that improper materials and techniques may lead to complications after intravitreal injections, e.g., inflammation; and recognizing that some devices may contribute to an enhanced, safer, and faster intravitreal injection technique.
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Affiliation(s)
- Gustavo Barreto Melo
- Hospital de Olhos de Sergipe, Rua Campo do Brito, 995, Aracaju, SE, Brazil; Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 806, São Paulo, SP, Brazil.
| | | | | | | | - Carsten H Meyer
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 806, São Paulo, SP, Brazil; Department of Ophthalmology, Philipps University of Marburg, Robert-Koch-Strasse 4, Marburg, Germany
| | - Susumu Uchiyama
- Department of Biotechnology, Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Osaka, Japan
| | - John Carpenter
- Department of Pharmaceutical Sciences, University of Colorado, Denver/Aurora, CO, USA
| | - Hélio Francisco Shiroma
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 806, São Paulo, SP, Brazil
| | - Michel Eid Farah
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 806, São Paulo, SP, Brazil
| | - Maurício Maia
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 806, São Paulo, SP, Brazil
| | - Eduardo Büchele Rodrigues
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 806, São Paulo, SP, Brazil; Department of Ophthalmology, SSM Health Saint Louis University Hospital, Saint Louis University, 1755, S. Grand Boulevard, Saint Louis, MO, USA
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