By Harry W. Flynn Jr, MD; Charles C. Wykoff, MD, PhD; Philip J. Rosenfeld, MD, PhD
    Subspecialty Day 2011: Retina

    Intravitreal injections are one of the most common medical procedures in the United States, and associated endophthalmitis occurs after approximately 1 out of 1000–5000 of these injections. While the community standard for preventing endophthalmitis continues to evolve, there appears to be a shift toward the use antisepsis and away from the use of peri-intravitreal injection antibiotics.

    In comparing prophylactic antisepsis with topical antibiotics, povidone-iodine has the advantages of low-cost, broad-spectrum activity, widespread availability, fast bactericidal rate, and absence of resistance. Data increasingly indicate that topical antibiotics, on the other hand, provide no benefit. Prophylactic antibiotic use, either before or after injection, is a significant financial burden on the health care system, may contribute to bacterial resistance, and is generally not recommended.