The role of preventive topical antibiotic treatment prior to intravitreal injection

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Treatment of wet age-related macular degeneration (AMD) requires frequent intravitreal injections of anti-VEGF agents, sometimes on monthly basis during a long period of time. Endophthalmitis is a rare but extremely severe complication of intravitreal injections. As it has been proven before, the flora from the conjunctival surface is the main source for endophthalmitis. Using Povidone-iodine solution (Betadine10 % Povidone-iodine, EGIS PHARMACEUTICALS) is the only way to prevent endophthalmitis. The efficacy of it was proven by numerous studies. No evidence exists that topical antibiotiotics prior and after injections could be effective for prevention of endophthalmitis. Purpose: To study the advisability of topical antibiotic application before intravitreal injection. Materials and methods: Under investigation, there were 25 eyes of 25 patients with wet AMD treated by anti-VEGF intravitreal injections. All patients used topical antibiotics 3 days before injection. Conjunctival culture from injection eye was collected three times: before topical antibiotic use; after topical antibiotic use, and after Betadine 5 % application. Results: The rates of Staphylococcus epidermidis before and after topical antibiotic use were approximately equal. However there was no Staphylococcus epidermidis found after Betadine 5 % application. Conclusion: Our study showed the effectiveness of Betadine 5 % solution in conjunctival flora reduction. Use of topical antibiotics 3 days prior intravitreal injections is not effective. Key words: age-related macular degeneration; endophthalmitis; intravitreal injection; topical antibiotics; endophthalmitis prevention.

Elena Vladimirovna Ageeva

I. P. Pavlov State Medical University

resident. Ophthalmology department

Anna Evgen'yevna Grodnenskaya

I. P. Pavlov State Medical University


Kseniya Aleksandrovna Popova

I. P. Pavlov State Medical University


  1. Bhavsar A. R., Ip M. S., Glassman A. R.; DRCRnet Study Group, SCORE Study Group. The risk of endophthalmitis following intravitreal triamcinolone injection in the DRCRnet and SCORE clinical trials. Am J Ophthalmol. 2007; 144: 454-6.
  2. Bhavsar A. R., Googe J. M. Jr., Stockdale C. R., Bressler N. M., Brucker A. J., Elman M. J., Glassman A. R. Diabetic Retinopathy Clinical Research Network: Risk of endophthalmitis after intravitreal drug injection when topical antibiotics are not required: the Diabetic Retinopathy Clinical Research Network Laser-Ranibizumab-Triamcinolone Clinical Trials. Arch. Ophthalmol. 2009; 127: 1581-3.
  3. Bannerman T. L., Rhoden D. L., McAllister S. K., Miller J. M., Wilson L. A. The source of coagulase negative staphylococci in the Endophthalmitis Vitrectomy Study. A comparison of eyelid and intraocular isolates using pulsed-field gel electrophoresis. Arch. Ophthalmol. 1997; 115: 357-61.
  4. Cheung C. S., Wong A. W., Lui A, Kertes P. J., Devenyi R. G., Lam W. C. Incidence of endophthalmitis and use of antibiotic prophylaxis after intravitreal injections. Ophthalmology. 2012; 119: 1609-14.
  5. Han D. P., Wisniewski S. R., Wilson L. A., Barza M., Vine A. K., Doft B. H., Kelsey S. F. Spectrum and susceptibilities of microbiological isolates in the Endophthalmitis Vitrectomy Study. Am J Ophthalmol. 1996; 122: 1-17.
  6. Haas W., Pillar C. M., Torres M., Morris T. W., Sahm D. F. Monitoring antibiotic resistance in ocular microorganisms: results from the Antibiotic Resistance Monitoring in Ocular micRorganisms (ARMOR) 2009 surveillance study. Am J Ophthalmol. 2011; 152 (4): 567-74.
  7. Isenberg S. J., Apt L., Yoshimori R., Khwarg S. Chemical preparation of the eye in ophthalmic surgery. IV. Comparison of povidone-iodine on the conjunctiva with a prophylactic antibiotic. Arch Ophthalmol. 1985; 103 (9): 1340-2.
  8. Jager R. D., Aiello L. P., Patel S. C., Cunningham E. T. Risks of intravitreous injection: a comprehensive review. Retina. 2004; 24: 676-98.
  9. Kim S. J., Toma H. S., Midha N. K., Cherney E. F., Recchia F. M., Doherty T. J. Antibiotic resistance of conjunctiva and nasopharynx evaluation study: a prospective study of patients undergoing intravitreal injections. Ophthalmology. 2010; 117: 2372-8.
  10. Moss J. M., Stanislo S. R., Ta C. Antibiotic susceptibility patterns of ocular bacterial flora in patients undergoing intravitreal injections. Ophthalmology 2010; 117: 2141-5.
  11. Mason J. O. III, White M. F., Feist R. M. et al. Incidence of acute onset endophthalmitis following intravitreal bevacizumab (Avastin) injection. Retina 2008; 28: 564-570.
  12. Moshirfar M., Feiz V., Vitale A. T., Wegelin J. A., Basavanthappa S., Wolsey D. H. Endophthalmitis after uncomplicated cataract surgery with the use of fourth-generation fluoroquinolones: a retrospective observational case series. Ophthalmology. 2007 Apr; 114 (4): 686-91 Epub 2006.
  13. Speaker M. G., Menikoff J. A. Prophylaxis of endophthalmitis with topical povidone-iodine. Ophthalmology. 1991; 98: 1769-75.
  14. Ta C. N., He L., M. de Kaspar H. In vitro antibiotic susceptibility of preoperative normal conjunctival bacteria. Eye (Lond). 2009; 23: 559-60.


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Copyright (c) 2015 Ageeva E.V., Grodnenskaya A.E., Popova K.A.

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