title: The role of topical antibiotic prophylaxis to prevent endophthalmitis after intravitreal injection.
abstract: OBJECTIVE
  To compare the incidence of endophthalmitis after intravitreal injection with and without topical postinjection antibiotic prophylaxis.
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  All patients treated with intravitreal injection of ranibizumab, bevacizumab, or aflibercept for a variety of retinal vascular diseases at a single, large retina practice between January 1, 2009, and October 1, 2012, were included.
  
  
  METHODS
  The total numbers of patients and injections were determined from a review of billing code and practice management records. Endophthalmitis cases were determined from billing records and from an infection log. All cases of endophthalmitis were confirmed with chart review. A 28-month period when topical antibiotics were prescribed after intravitreal injection was compared with a 9-month period when topical antibiotics were not prescribed. Patients treated during an 8-month transition period were excluded to allow for the conversion of antibiotic prescription practices.
  
  
  METHODS
  Incidence of endophthalmitis, visual acuity outcomes, and microbial spectrum.
  
  
  RESULTS
  During the study period, a total of 117 171 intravitreal injections were performed (57 654 injections during the topical antibiotic period, 24 617 during the transition period, and 34 900 during the no-antibiotic period), with a total of 44 cases of suspected endophthalmitis (0.038%; 1 in 2663 injections), 17 of which showed culture-positive results (0.015%; 1 in 6892 injections). During the 28-month topical antibiotic period, there were 28 cases of suspected endophthalmitis (0.049%; 1 in 2059 injections), 10 of which showed culture-positive results (0.017%; 1 in 5765 injections). During the 9-month no-antibiotic period, there were 11 cases of suspected endophthalmitis (0.032%; 1 in 3173 injections), 4 of which showed culture-positive results (0.011%; 1 in 8725 injections). Topical antibiotic use was associated with a trend toward increased risk of suspected endophthalmitis (odds ratio [OR], 1.54; 95% confidence interval [CI], 0.77-3.10) and culture-positive endophthalmitis (OR, 1.51; 95% CI, 0.47-4.83).
  
  
  CONCLUSIONS
  The incidence of endophthalmitis after intravitreal injection is low. Using postinjection topical antibiotic drops does not reduce the risk of endophthalmitis developing and is associated with a trend toward higher incidence of endophthalmitis.
authors.affiliation: The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Philip
authors.initials: P
authors.lastname: Storey
authors.affiliation: The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Michael
authors.initials: M
authors.lastname: Dollin
authors.affiliation: The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: John
authors.initials: J
authors.lastname: Pitcher
authors.affiliation: Department of Ophthalmology, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Sahitya
authors.initials: S
authors.lastname: Reddy
authors.affiliation: Department of Ophthalmology, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Joseph
authors.initials: J
authors.lastname: Vojtko
authors.affiliation: The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: James
authors.initials: J
authors.lastname: Vander
authors.affiliation: The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Jason
authors.initials: J
authors.lastname: Hsu
authors.affiliation: The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address: sunirgarg@yahoo.com.
authors.forename: Sunir J
authors.initials: SJ
authors.lastname: Garg
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000583:Amikacin / Q000627:therapeutic use; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001419:Bacteria / Q000302:isolation & purification; D016022:Case-Control Studies; D002442:Ceftazidime / Q000627:therapeutic use; D009877:Endophthalmitis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D015818:Eye Infections, Bacterial / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D012164:Retinal Diseases / Q000188:drug therapy; D012189:Retrospective Studies; D014640:Vancomycin / Q000627:therapeutic use; D014792:Visual Acuity; D014822:Vitreous Body / Q000382:microbiology
chemical_list: D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; D009883:Ophthalmic Solutions; D014640:Vancomycin; D000583:Amikacin; D002442:Ceftazidime