Risk of endophthalmitis after intravitreal drug injection when topical antibiotics are not required: the diabetic retinopathy clinical research network laser-ranibizumab-triamcinolone clinical trials.
OBJECTIVE
To report the incidence of endophthalmitis after intravitreal drug injection by means of a standardized procedure that does not require topical antibiotics, sterile gloves, or a sterile drape.


METHODS
Intravitreal injections of preservative-free triamcinolone acetonide or ranibizumab were administered in 2 prospective randomized clinical trials performed by the Diabetic Retinopathy Clinical Research Network. The standardized procedure for these trials requires the use of a topical combination product of povidone-iodine, a sterile lid speculum, and topical anesthetic, but does not require the use of topical antibiotics before, on the day of, or after injection.


RESULTS
As of February 23, 2009, a total of 3226 intravitreal injections of ranibizumab and 612 injections of preservative-free triamcinolone had been administered. Topical antibiotics were given on the day of injection in 361 (9.4%) of the 3838 cases, for several days after injection in 813 cases (21.2%), on the day of injection and after injection in 1388 cases (36.2%), and neither on the day of injection nor after injection in 1276 cases (33.3%). Three cases of culture-positive endophthalmitis occurred after ranibizumab injections (0.09%), and no cases occurred after triamcinolone injections. In all 3 cases of endophthalmitis, topical antibiotics were given for several days after the injection but not before injection.


CONCLUSIONS
The results suggest that a low rate of endophthalmitis can be achieved by means of a protocol that includes use of topical povidone-iodine, a sterile lid speculum, and topical anesthetic, but does not require topical antibiotics, sterile gloves, or a sterile drape. Trial Registration clinicaltrials.gov Identifiers: NCT00444600 and NCT00445003.
Bhavsar
Abdhish R
AR
Jaeb Center for Health Research, 15310 Amberly Dr, Ste 350, Tampa, FL 33647, USA.
Googe
Joseph M
JM
Stockdale
Cynthia R
CR
Bressler
Neil M
NM
Brucker
Alexander J
AJ
Elman
Michael J
MJ
Glassman
Adam R
AR
D000779:Anesthetics, Local / Q000008:administration & dosage; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D004203:Disinfection / Q000379:methods; D009877:Endophthalmitis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D015818:Eye Infections, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007267:Injections; D017075:Laser Coagulation; D008268:Macular Degeneration / Q000628:therapy; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D011206:Povidone-Iodine / Q000008:administration & dosage; D011446:Prospective Studies; D000069579:Ranibizumab; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D013290:Streptococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D034363:Viridans Streptococci / Q000302:isolation & purification; D014822:Vitreous Body
D000779:Anesthetics, Local; D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; D042461:Vascular Endothelial Growth Factor A; D011206:Povidone-Iodine; D014222:Triamcinolone Acetonide; D000069579:Ranibizumab