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Acta Ophthalmol. 2018 Aug;96(5):435-441. doi: 10.1111/aos.13417. Epub 2017 Apr 25.

Topical antibiotics and intravitreal injections.

Author information

1
University of Sydney, Sydney, New South Wales, Australia.
2
Sydney Eye Hospital, Sydney, New South Wales, Australia.
3
Sydney and Macquarie Universities, Sydney, New South Wales, Australia.
4
Concord Repatriation General Hospital, Concord, New South Wales, Australia.
5
Royal North Shore Hospital, St Leonards, New South Wales, Australia.
6
Service d'ophtalmologie, CHU de Bordeaux, Bordeaux, France.
7
Univ. Bordeaux, ISPED, Bordeaux, France.
8
Inserm, U1219 - Bordeaux Population Health Research Center, Bordeaux, France.
9
University of Udine, Udine, Italy.
10
Kyorin University School of Medicine, Tokyo, Japan.

Abstract

There is increasing evidence that topical antibiotics, given before and/or after intravitreal injections, are ineffective in preventing endophthalmitis and are possibly harmful. In addition to the lack of efficacy and increased development of resistant organisms, the use of topical antibiotics adds significantly to the cost of delivering intravitreal therapy. Despite this, in many countries, it is still common practice to use pre- and/or postinjection topical antibiotics. This review outlines the general principles of effective antibiotic prophylaxis, and the evidence regarding topical antibiotic use as a prophylactic measure for endophthalmitis following intravitreal injections. A key distinguishing feature of intravitreal injections from most other invasive procedures is the fact that they are often repeated on multiple occasions to the same eye. Given the lack of evidence to support topical antibiotics as an effective method of prophylaxis for postinjection endophthalmitis, it appears that more widespread education of ophthalmologists is required to avoid continued inappropriate use. Revision of drug labels in some jurisdictions, and amendment of local/professional society guidelines, may be required to assist in achieving this goal. Emphasis should be placed on antisepsis and aseptic technique, which are the major proven methods of endophthalmitis prevention, rather than antibiotics.

KEYWORDS:

endophthalmitis; intravitreal; prophylaxis; topical antibiotics

PMID:
28440583
DOI:
10.1111/aos.13417
[Indexed for MEDLINE]

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