MAY 20, 2008
This large retrospective chart review of all 5,233 intravitreal Avastin injections given in a tertiary vitroretinal group practice over a 23-month period was conducted in order to determine the endophthalmitis rate. The authors found a very low rate of endophthalmitis and linked this to the use of preinjection povidone-iodine solution.
Patients included in the study had received intravitreal Avastin for conditions, including neovascular age-related macular degeneration, branch retinal vein occlusion, central retinal vein occlusion, cystoid macular edema, proliferative diabetic retinopathy, and diabetic macular edema. Before all injections, topical proparacaine and 4% lidocaine were placed in the eye and then 5% povidone-iodine solution applied to the eyelids, lashes, and conjunctiva for two minutes. A lid speculum was used in about half of injections, as was postinjection gatifloxacin.
The authors identified only one case of endophthalmitis, which yielded a very low occurrence rate of 0.019 percent. This is yet another study confirming that the best prophylaxis against endophthalmitis is the use of povidone-iodine solution prior to giving an injection. This study also brings into question, once again, the possible benefit of postinjection antibiotic drops, since the single case of endophthalmitis occurred in a patient who used postinjection antibiotic eye drops.
Dr. Flaxel has no financial relationships to disclose.