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2015 ; 1
(ä): 9
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Endophthalmitis following intravitreal anti-vascular endothelial growth factor
(VEGF) injection: a comprehensive review
#MMPMID27847602
Merani R
; Hunyor AP
Int J Retina Vitreous
2015[]; 1
(ä): 9
PMID27847602
show ga
The purpose of this review is to report and summarize previously reported studies
and assess many of the individual steps of the intravitreal injection procedure's
possible effect on the prevention of endophthalmitis. The pooled endophthalmitis
rate from 20 large retrospective case series of anti-VEGF injections was
144/510,396 (0.028%; 1/3,544). Injections may be performed in an office-based
location or in an operating room (OR) and low rates of endophthalmitis can be
achieved in either location with careful attention to asepsis. Pre- or
post-injection topical antibiotics have not been shown to be effective, and could
select for more virulent microorganisms. Povidone-iodine prior to injection is
accepted as the gold-standard antiseptic agent, but aqueous chlorhexidine may be
an alternative. Antisepsis before and after gel or subconjunctival anesthetic is
suggested. The preponderance of Streptococcal infections after intravitreal
injection is discussed, including the possible role of aerosolization, which can
be minimized by using face masks or maintaining silence. As with other invasive
procedures in medicine, the use of sterile gloves, following adequate hand
antisepsis, may be considered. Control of the eyelashes and lid margin is
required to avoid contamination of the needle, but this can be achieved with or
without a speculum. Techniques to minimize vitreous reflux have not been shown to
reduce the risk of endophthalmitis. Same day bilateral injections should be
performed as two separate procedures, preferably using drug from different lots,
especially when using compounded drugs.