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Trovato Battagliola E, Riveros Cabral RJ, Manco G, Puggioni G, Brancato C, Mangiantini P, Testa F, Malvasi M, Raponi G, Turchetti P, Pacella F, Pacella E. Topical antibiotic prophylaxis before intravitreal injections: a pilot study. Graefes Arch Clin Exp Ophthalmol 2023; 261:2953-2959. [PMID: 37199800 DOI: 10.1007/s00417-023-06113-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/21/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE To explore whether topical antibiotic prophylaxis in patients scheduled for intravitreal injections achieves surface sterility in a greater proportion of subjects as compared to povidone-iodine alone. MATERIAL AND METHODS A randomized, triple-blind clinical trial. POPULATION patients scheduled for intravitreal injections for maculopathy. INCLUSION CRITERIA any sex and race, age 18 years and above. Subjects were randomized into 4 groups: the first group applied chloramphenicol (CHLORAM), the second netilmicin (NETILM), the third a commercial ozonized antiseptic solution (OZONE), and the fourth applied no drops (CONTROL). OUTCOME VARIABLE percentage of non-sterile conjunctival swabs. Specimens were collected before and after the application of 5% povidone-iodine moments before the injection. RESULTS Ninety-eight subjects (33.7% females, 64.3% males), mean age: 70.2 ± 9.3 years (54-91). Before povidone-iodine, both the CHLORAM and NETILM group showed a lower percentage of non-sterile swabs (61.1% and 31.3% respectively), as compared to the OZONE (83.3%) and CONTROL (86.5%) groups (p < .04). However, this statistical difference was lost after the application of povidone-iodine for 3 min. Percentage of non-sterile swabs in each group after applying 5% povidone-iodine: CHLORAM 11.1%, NETILM 12.5%, CONTROL 15.4%, OZONE 25.0%. This was not statistically significant (p > .05). CONCLUSIONS Topical antibiotic prophylaxis with chloramphenicol or netilmicin drops decreases the bacterial load on the conjunctiva. However, after the application of povidone-iodine, all groups showed a significant reduction in the percentage of non-sterile swabs, and this value was comparable among all groups. For this reason, authors conclude that povidone-iodine alone is sufficient and prior topical antibiotic prophylaxis is not indicated.
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Affiliation(s)
- Edoardo Trovato Battagliola
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Rodolfo Javier Riveros Cabral
- Department of Diagnostic Medicine and Radiology, UOC Microbiology and Virology, Azienda Policlinico Umberto I, Rome, Italy
| | - Gregorio Manco
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Gianluca Puggioni
- Department of Diagnostic Medicine and Radiology, UOC Microbiology and Virology, Azienda Policlinico Umberto I, Rome, Italy
| | - Claudio Brancato
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Pietro Mangiantini
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Floriana Testa
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Mariaelena Malvasi
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Giammarco Raponi
- Department of Public Health and Infectious Diseases, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Turchetti
- National Institute for Health Migration and Poverty, Rome, Italy
| | - Fernanda Pacella
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Elena Pacella
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy.
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Patel SN, Gangaputra S, Sternberg P, Kim SJ. Prophylaxis measures for postinjection endophthalmitis. Surv Ophthalmol 2020; 65:408-420. [PMID: 31923477 DOI: 10.1016/j.survophthal.2019.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/24/2019] [Accepted: 12/30/2019] [Indexed: 12/23/2022]
Abstract
Intravitreal injections have become the most commonly performed ophthalmic procedure, transforming modern retina practice. Postinjection endophthalmitis, while rare, remains the most feared potential complication. Prophylaxis measures including topical antisepsis, hand hygiene, gloves, masks, and drapes have all been proposed to help prevent postinjection endophthalmitis; however, there remains significant variation in protocol, given the lack of agreement among retina specialists on which steps are crucial to prevent endophthalmitis. With millions of injections performed annually, collating data have helped us better understand risk factors for endophthalmitis after intravitreal injection. We summarize the consensus guidelines for intravitreal injection technique and comprehensively review the literature on prevention of postinjection endophthalmitis.
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Affiliation(s)
- Shriji N Patel
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Sapna Gangaputra
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Paul Sternberg
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Stephen J Kim
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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