title: Endophthalmitis After Intravitreal Injections in Patients With Self-reported Iodine Allergy.
abstract: OBJECTIVE
  To present cases of endophthalmitis following intravitreal injections where povidone-iodine (PI) was not used as part of the surgical preparation.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  All cases of presumed injection-related endophthalmitis presenting to the Massachusetts Eye and Ear Infirmary between June 2008 and November 2014 and Dean McGee Eye Institute between January 2010 and January 2015 were identified. Patients who did not receive PI preparation owing to documented self-reported allergy to iodine, iodine-containing contrast material, or shellfish were identified and their injection histories and clinical courses reviewed.
  
  
  RESULTS
  The combined rate of postinjection endophthalmitis at these 2 centers was 0.019%. Among 42 patients with postinjection endophthalmitis, 5 (11.9%) did not receive PI prophylaxis. The mean number of intravitreal injections without PI before the development of endophthalmitis was 10.6 with a 9.4% rate of endophthalmitis (5 cases per 53 injections). All patients underwent tap-and-inject procedures with vancomycin 1 mg and ceftazidime 2 mg. Two patients did not receive PI at the time of tap and inject; 1 of these patients required subsequent pars plana vitrectomy for worsening clinical course. Cultures were positive in 4 of 5 cases; all positive cultures grew coagulase-negative Staphylococcus. All patients who received subsequent intravitreal injections received PI prophylaxis without allergic reactions, thus demonstrating a lack of true PI allergy.
  
  
  CONCLUSIONS
  Avoiding PI owing to self-reported iodine "allergy" risks substantial ocular morbidity. Allergy testing can be pursued per patient request or in rare cases of suspected true PI allergy; however, in cases where delayed treatment would adversely affect visual outcome, the clinician should feel confident that minimal allergic risk exists.
authors.affiliation: Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
authors.forename: Bobeck S
authors.initials: BS
authors.lastname: Modjtahedi
authors.affiliation: Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
authors.forename: Tavé
authors.initials: T
authors.lastname: van Zyl
authors.affiliation: Retina Service, Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma.
authors.forename: Hemang K
authors.initials: HK
authors.lastname: Pandya
authors.affiliation: Retina Service, Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Leonard
authors.affiliation: Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts. Electronic address: Dean_Eliott@meei.harvard.edu.
authors.forename: Dean
authors.initials: D
authors.lastname: Eliott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004342:Drug Hypersensitivity / Q000209:etiology*; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D058449:Intravitreal Injections / Q000009:adverse effects*; D008875:Middle Aged; D011206:Povidone-Iodine / Q000009:adverse effects*; D012189:Retrospective Studies; D057566:Self Report; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D013210:Staphylococcus / Q000302:isolation & purification; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D011206:Povidone-Iodine