Risk of endophthalmitis after intravitreal drug injection when topical antibiotics are not required

The diabetic retinopathy clinical research network laser-ranibizumab-triamcinolone clinical trials

Abdhish R. Bhavsar, Joseph Googe, Cynthia R. Stockdale, Neil M. Bressler, Alexander J. Brucker, Michael J. Elman, Adam R. Glassman

Research output: Contribution to journalArticle

112 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1581-1583
Number of pages3
JournalArchives of Ophthalmology
Volume127
Issue number12
DOIs
StatePublished - Dec 1 2009

Fingerprint

Triamcinolone
Intravitreal Injections
Endophthalmitis
Diabetic Retinopathy
Lasers
Clinical Trials
Anti-Bacterial Agents
Injections
Research
Pharmaceutical Preparations
Povidone-Iodine
Local Anesthetics
Surgical Instruments
Ranibizumab
Triamcinolone Acetonide
Randomized Controlled Trials

All Science Journal Classification (ASJC) codes

  • Ophthalmology

Cite this

Risk of endophthalmitis after intravitreal drug injection when topical antibiotics are not required : The diabetic retinopathy clinical research network laser-ranibizumab-triamcinolone clinical trials. / Bhavsar, Abdhish R.; Googe, Joseph; Stockdale, Cynthia R.; Bressler, Neil M.; Brucker, Alexander J.; Elman, Michael J.; Glassman, Adam R.

In: Archives of Ophthalmology, Vol. 127, No. 12, 01.12.2009, p. 1581-1583.

Research output: Contribution to journalArticle

Bhavsar, Abdhish R. ; Googe, Joseph ; Stockdale, Cynthia R. ; Bressler, Neil M. ; Brucker, Alexander J. ; Elman, Michael J. ; Glassman, Adam R. / Risk of endophthalmitis after intravitreal drug injection when topical antibiotics are not required : The diabetic retinopathy clinical research network laser-ranibizumab-triamcinolone clinical trials. In: Archives of Ophthalmology. 2009 ; Vol. 127, No. 12. pp. 1581-1583.
@article{1eedc0a17e82430c93af044ccef0ef36,
title = "Risk of endophthalmitis after intravitreal drug injection when topical antibiotics are not required: The diabetic retinopathy clinical research network laser-ranibizumab-triamcinolone clinical trials",
abstract = "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.",
author = "Bhavsar, {Abdhish R.} and Joseph Googe and Stockdale, {Cynthia R.} and Bressler, {Neil M.} and Brucker, {Alexander J.} and Elman, {Michael J.} and Glassman, {Adam R.}",
year = "2009",
month = "12",
day = "1",
doi = "10.1001/archophthalmol.2009.304",
language = "English (US)",
volume = "127",
pages = "1581--1583",
journal = "JAMA Ophthalmology",
issn = "2168-6165",
publisher = "American Medical Association",
number = "12",

}

TY - JOUR

T1 - Risk of endophthalmitis after intravitreal drug injection when topical antibiotics are not required

T2 - The diabetic retinopathy clinical research network laser-ranibizumab-triamcinolone clinical trials

AU - Bhavsar, Abdhish R.

AU - Googe, Joseph

AU - Stockdale, Cynthia R.

AU - Bressler, Neil M.

AU - Brucker, Alexander J.

AU - Elman, Michael J.

AU - Glassman, Adam R.

PY - 2009/12/1

Y1 - 2009/12/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=73349107165&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=73349107165&partnerID=8YFLogxK

U2 - 10.1001/archophthalmol.2009.304

DO - 10.1001/archophthalmol.2009.304

M3 - Article

VL - 127

SP - 1581

EP - 1583

JO - JAMA Ophthalmology

JF - JAMA Ophthalmology

SN - 2168-6165

IS - 12

ER -