title: Eliminating antibiotic prophylaxis for intravitreal injections: a consecutive series of 18,839 injections by a single surgeon.
abstract: OBJECTIVE
  By optimizing the protocol for intravitreal injections, the risk of endophthalmitis can be minimized. This study assesses the incidence of endophthalmitis and other complications after a consecutive series of intravitreal injections where all antibiotics were excluded.
  
  
  METHODS
  Injections were performed from August 1, 1997 to October 31, 2012 in outpatient examination rooms at the Retina Center of Minnesota by a single retinal surgeon, the lead author. Most injections were performed to treat exudative age-related macular degeneration. Other reasons included diabetic macular edema, cystoid macular edema because of retinal vein occlusions, cytomegalovirus retinitis, and severe uveitis. Injections were given with topical povidone-iodine, proparacaine, and tetracaine, a sterile eyelid speculum, and clean nonsterile gloves, but without any antibiotics. Data were retrospectively analyzed using billing codes from a computer database system.
  
  
  RESULTS
  A total of 18,839 injections were given. Of these, the following injections were administered: bevacizumab, 15,479 (82.16%); ranibizumab, 1,669 (8.86%); triamcinolone acetonide (Kenalog-40), 1,014 (5.38%); pegaptanib sodium, 370 (1.96%); aflibercept, 148 (0.79%); dexamethasone implant, 88 (0.47%); triamcinolone acetonide (Triesence), 32 (0.17%); dexamethasone, 29 (0.15%); and ganciclovir, 10 (0.05%). There was one case of postinjection endophthalmitis. The incidence of endophthalmitis per injection was 0.0053%.
  
  
  CONCLUSIONS
  A low incidence of endophthalmitis can be achieved when topical antibiotics are omitted.
authors.affiliation: *Retina Center of Minnesota, Minneapolis, Minnesota; and †Midwestern University, Glendale, Arizona.
authors.forename: Abdhish R
authors.initials: AR
authors.lastname: Bhavsar
authors.forename: Danielle R
authors.initials: DR
authors.lastname: Sandler
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis / Q000379:methods*; D009877:Endophthalmitis / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009883:Ophthalmic Solutions; D010818:Practice Patterns, Physicians'; D012164:Retinal Diseases / Q000188:drug therapy; D012189:Retrospective Studies
chemical_list: D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D009883:Ophthalmic Solutions