title: Aqueous Chlorhexidine for Intravitreal Injection Antisepsis: A Case Series and Review of the Literature.
abstract: To determine the incidence of endophthalmitis in a large clinical series using aqueous chlorhexidine for antisepsis before intravitreal injection and to review the ophthalmic literature regarding chlorhexidine efficacy and safety.
  
  
  
  Multicenter retrospective case series.
  
  
  
  All patients receiving intravitreal injections from 7 retinal specialists.
  
  
  
  An audit of intravitreal injections performed by retinal specialists who exclusively used aqueous chlorhexidine 0.05% or 0.1% for prophylaxis of infective endophthalmitis was undertaken. The incidence of endophthalmitis was determined from August 1, 2011, to February 28, 2015. A literature review was performed to critically appraise the ocular safety and efficacy of aqueous chlorhexidine.
  
  
  
  Incidence of endophthalmitis after intravitreal injections.
  
  
  
  A total of 40 535 intravitreal injections were performed by 7 retinal specialists across 3 centers. Chlorhexidine was well tolerated, and only 1 patient with a suspected allergic reaction was noted. Three cases of endophthalmitis were identified with 1 culture-positive case. The 0.0074% (1 in 13 512) per-injection rate of endophthalmitis in this series compares favorably with previous series in which povidone-iodine has been used.
  
  
  
  Aqueous chlorhexidine was associated with a low rate of postinjection endophthalmitis and was well tolerated by patients.
authors.affiliation: Save Sight Institute, University of Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, NSW, Australia; Concord Repatriation General Hospital, Concord NSW, Australia; Retina Associates, Chatswood, NSW, Australia.
authors.forename: Rohan
authors.initials: R
authors.lastname: Merani
authors.affiliation: The University of Newcastle, Newcastle, NSW, Australia.
authors.forename: Zachary E
authors.initials: ZE
authors.lastname: McPherson
authors.affiliation: Eye Clinic Albury Wodonga, Albury, NSW, Australia.
authors.forename: Alan P
authors.initials: AP
authors.lastname: Luckie
authors.affiliation: South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, SA, Australia; Adelaide Eye and Retina Centre, Adelaide, SA, Australia.
authors.forename: Jagjit S
authors.initials: JS
authors.lastname: Gilhotra
authors.affiliation: Adelaide Eye and Retina Centre, Adelaide, SA, Australia.
authors.forename: Jim
authors.initials: J
authors.lastname: Runciman
authors.affiliation: Adelaide Eye and Retina Centre, Adelaide, SA, Australia.
authors.forename: Shane
authors.initials: S
authors.lastname: Durkin
authors.affiliation: Adelaide Eye and Retina Centre, Adelaide, SA, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Muecke
authors.affiliation: Terrace Eye Centre, Brisbane, Qld, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Donaldson
authors.affiliation: Terrace Eye Centre, Brisbane, Qld, Australia.
authors.forename: Albert
authors.initials: A
authors.lastname: Aralar
authors.affiliation: Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia.
authors.forename: Anupam
authors.initials: A
authors.lastname: Rao
authors.affiliation: The University of Newcastle, Newcastle, NSW, Australia; Newcastle Eye Hospital, Newcastle, NSW, Australia. Electronic address: drpeterdavies@bigpond.com.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Davies
mesh_terms: D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D000985:Antisepsis / Q000379:methods; D002710:Chlorhexidine / Q000627:therapeutic use*; D009877:Endophthalmitis / Q000453:epidemiology* / Q000517:prevention & control; D015818:Eye Infections, Bacterial / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D058449:Intravitreal Injections; D008297:Male; D008485:Medical Audit; D000069579:Ranibizumab / Q000627:therapeutic use; D040262:Receptors, Vascular Endothelial Growth Factor / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D057135:Wet Macular Degeneration / Q000188:drug therapy
chemical_list: D020533:Angiogenesis Inhibitors; D000891:Anti-Infective Agents, Local; D011993:Recombinant Fusion Proteins; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor; D002710:Chlorhexidine; D000069579:Ranibizumab