Specification of intravitreal injections procedures to reduce the incidence of endophthalmitis_Chinese Journal of Ocular Fundus Diseases

Authors：

 Zhang Wenfang , Yang Yi

Department of Ophthalmology, Lanzhou University Second Hospital, Lanzhou 730000, China;

Corresponding author：

Zhang Wenfang, Email: zhwenf888@163.com

Keywords：

Intravitreal injections; Endophthalmitis; Editorial

DOI：

10.3760/cma.j.cn511434-20210909-00500

Video：

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Endophthalmitis caused by intravitreal injection is a rare disease which impair patients’s vision. In recent years, with the increase of the diseases and frequency of intravitreal injections, the incidence of endophthalmitis has increased. Standardizing each step of intravitreal injections is an important method to reduce postoperative endophthalmitis. Despite the current availability of prevention strategies providing by a lot of clinical trials, there are considerable variations and a lack of consensus and inconsistencies in clinical practice. Understanding the existing key measures, standardizing the operation of intravitreal injection in my country, and minimizing the incidence of infective endophthalmitis are of positive significance for improving the treatment of ophthalmology, especially fundus diseases.

Citation： Zhang Wenfang, Yang Yi. Specification of intravitreal injections procedures to reduce the incidence of endophthalmitis. Chinese Journal of Ocular Fundus Diseases, 2021, 37(9): 670-674. doi: 10.3760/cma.j.cn511434-20210909-00500 Copy

1.	Barnes AC, Rathbun SL, Kuthyar S, et al. Clinical management of an outbreak of nutritionally variant streptococcus endophthalmitis following intravitreal bevacizumab injection[J/OL]. Int J Retina Vitreous, 2021, 7(1): 18[2021-03-04]. https://pubmed.ncbi.nlm.nih.gov/33663619/. DOI: 10.1186/s40942-021-00287-8.
2.	Kaldirim H, Yazgan S, Kirgiz A, et al. Effect of opical antibiotic prophylaxis on conjunctival flora and antibiotic resistance following intravitreal injections in patients with type 2 diabetes[J]. Korean J Ophthalmol, 2020, 34(4): 265-273. DOI: 10.3341/kjo.2019.0144.
3.	Morioka M, Takamura Y, Nagai K, et al. Incidence of endophthalmitis after intravitreal injection of an anti-VEGF agent with or without topical antibiotics[J/OL]. Sci Rep, 2020, 10(1): 22122[2020-12-17]. https://pubmed.ncbi.nlm.nih.gov/33335269/. DOI: 10.1038/s41598-020-79377.
4.	中华医学会眼科学分会眼底病学组. 我国视网膜病玻璃体腔注药术质量控制标准[J]. 中华眼科杂志, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.Fundus Ophthalmology Group, Ophthalmology Branch of Chinese Medical Association. Quality control standards for intravitreal injection of retinopathy in my country[J]. Chin J Ophthalmol, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.
5.	Bhatt SS, Stepien KE, Joshi K. Prophylactic antibiotic use after intravitreal injection: effect on endophthalmitis rate[J]. Retina, 2011, 31(10): 2032-2036. DOI: 10.1097/IAE.0b013e31820f4b4f.
6.	Benoist d'Azy C, Pereira B, Naughton G, et al. Antibioprophylaxis in prevention of endophthalmitis in intravitreal injection: a systematic review and meta-analysis[J/OL]. PLoS One, 2016, 11(6): e0156431[2016-06-03]. https://pubmed.ncbi.nlm.nih.gov/27257676/. DOI: 10.1371/journal.pone.0156431.
7.	Bande MF, Mansilla R, Pata MP, et al. Intravitreal injections of anti-VEGF agents and antibiotic prophylaxis for endophthalmitis: a systematic review and meta-analysis[J/OL]. Sci Rep, 2017, 7(1): 18088[2017-12-22]. https://pubmed.ncbi.nlm.nih.gov/29273773/. DOI: 10.1038/s41598-017-18412-9.
8.	Menchini F, Toneatto G, Miele A, et al. Antibiotic prophylaxis for preventing endophthalmitis after intravitreal injection: a systematic review[J]. Eye (Lond), 2018, 32(9): 1423-1431. DOI: 10.1038/s41433-018-0138-8.
9.	Merani R, Hunyor AP. Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review[J/OL]. Int J Retina Vitreous, 2015, 1: 9[2015-07-21]. https://pubmed.ncbi.nlm.nih.gov/27847602/. DOI: 10.1186/s40942-015-0010-y.
10.	Yin VT, Weisbrod DJ, Eng KT, et al. Antibiotic resistance of ocular surface flora with repeated use of a topical antibiotic after intravitreal injection[J]. JAMA Ophthalmol, 2013, 131(4): 456-461. DOI: 10.1001/jamaophthalmol.2013.2379.
11.	hrestha R, Karki P, Joshi SN. Outcome of intravitreal bevacizumab injection without pre and postoperative antibiotics[J/OL]. BMC Ophthalmol, 2020, 20(1): 145[2020-04-15]. https://pubmed.ncbi.nlm.nih.gov/32293351/. DOI: 10.1186/s12886-020-01420-1.
12.	Miño De Kaspar H, Hoepfner AS, Engelbert M, et al. Antibiotic resistance pattern and visual outcome in experimentally-induced Staphylococcus epidermidis endophthalmitis in a rabbit model[J]. Ophthalmology, 2001, 108(3): 470-478. DOI: 10.1016/s0161-6420(00)00545-5.
13.	Stem MS, Rao P, Lee IJ, et al. Predictors of endophthalmitis after intravitreal injection: a multivariable analysis based on injection protocol and povidone iodine strength[J]. Ophthalmol Retina, 2019, 3(1): 3-7. DOI: 10.1016/j.oret.2018.09.013.
14.	Grzybowski A, Told R, Sacu S, et al. 2018 update on intravitreal injections: euretina expert consensus recommendations[J]. Ophthalmologica, 2018, 239(4): 181-193. DOI: 10.1159/000486145.
15.	Ferguson AW, Scott JA, McGavigan J, et al. Comparison of 5% povidone-iodine solution against 1% povidone-iodine solution in preoperative cataract surgery antisepsis: a prospective randomised double blind study[J]. Br J Ophthalmol, 2003, 87(2): 163-167. DOI: 10.1136/bjo.87.2.163.
16.	Musumeci R, Troiano P, Martinelli M, et al. Effectiveness of 0.66% povidone-iodine eye drops on ocular surface flora before cataract surgery: a nationwide microbiological study[J/OL]. J Clin Med, 2021, 10(10): 2198[2019-05-19]. https://pubmed.ncbi.nlm.nih.gov/34069600/. DOI: 10.3390/jcm10102198.
17.	Koerner J, Grzybowski A. Povidone-iodine pharmacokinetics and study design[J/OL]. BMC Ophthalmol, 2020, 20(1): 29[2020-01-17]. https://pubmed.ncbi.nlm.nih.gov/31952486/. DOI: 10.1186/s12886-020-1313-9.
18.	Jiang J, Wu M, Shen T. The toxic effect of different concentrations of povidone iodine on the rabbit's cornea[J]. Cutan Ocul Toxicol, 2009, 28(3): 119-124. DOI: 10.1080/15569520903080511.
19.	Simonett JM, Igelman A, Taylor SC, et al. Culture-proven endophthalmitis after intravitreal injection: a 10-year analysis[J]. Ophthalmic Surg Lasers Imaging Retina, 2019, 50(1): 33-38. DOI: 10.3928/23258160-20181212-05.
20.	Labardini CP, Blumenthal EZ. Causative pathogens in endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents[J]. Rambam Maimonides Med J, 2018, 9(4): 1-6. DOI: 10.5041/RMMJ.10348.
21.	Writing committee for the Post-Injection Endophthalmitis Study Group, Patel SN, Tang PH, et al. The influence of universal face mask use on endophthalmitis risk after intravitreal anti-vascular endothelial growth factor injections[J/OL]. Ophthalmology, 2021[2021-05-18]. https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(21)00368-7. DOI: 10.1016/j.ophtha.2021.05.010. [published online ahead of print].
22.	Chen Y, Wei W, Vavvas DG, et al. Incidence of endophthalmitis after intravitreal anti-vascular endothelial growth factor injections in an operating room in China[J/OL]. J Ophthalmol, 2020, 2020: 5163484[2020-11-12]. https://pubmed.ncbi.nlm.nih.gov/33815833/. DOI: 10.1155/2020/5163484.
23.	Shaheen F, Awan MA, Hafeez A, et al. Incidence of endophthalmitis following intravitreal anti VEGF injections at a tertiary care hospital in Pakistan[J]. J Pak Med Assoc, 2021, 71(4): 1184-1188. DOI: 10.47391/JPMA.212.
24.	Kiss S, Dugel PU, Khanani AM, et al. Endophthalmitis rates among patients receiving intravitreal anti-VEGF injections: a USA claims analysis[J]. Clin Ophthalmol, 2018, 12: 1625-1635. DOI: 10.2147/OPTH.S169143.
25.	VanderBeek BL, Bonaffini SG, Ma L. The association between intravitreal steroids and post-injection endophthalmitis rates[J]. Ophthalmology, 2015, 122(11): 2311-2315.e1. DOI: 10.1016/j.ophtha.2015.07.005.
26.	Abu-Yaghi NE, Shokry AN, Abu-Sbeit RH. Bilateral same-session intravitreal injections of anti-vascular endothelial growth factors[J]. Int J Ophthalmol, 2014, 7(6): 1017-1021. DOI: 10.3980/j.issn.2222-3959.2014.06.20.

1. Barnes AC, Rathbun SL, Kuthyar S, et al. Clinical management of an outbreak of nutritionally variant streptococcus endophthalmitis following intravitreal bevacizumab injection[J/OL]. Int J Retina Vitreous, 2021, 7(1): 18[2021-03-04]. https://pubmed.ncbi.nlm.nih.gov/33663619/. DOI: 10.1186/s40942-021-00287-8.
2. Kaldirim H, Yazgan S, Kirgiz A, et al. Effect of opical antibiotic prophylaxis on conjunctival flora and antibiotic resistance following intravitreal injections in patients with type 2 diabetes[J]. Korean J Ophthalmol, 2020, 34(4): 265-273. DOI: 10.3341/kjo.2019.0144.
3. Morioka M, Takamura Y, Nagai K, et al. Incidence of endophthalmitis after intravitreal injection of an anti-VEGF agent with or without topical antibiotics[J/OL]. Sci Rep, 2020, 10(1): 22122[2020-12-17]. https://pubmed.ncbi.nlm.nih.gov/33335269/. DOI: 10.1038/s41598-020-79377.
4. 中华医学会眼科学分会眼底病学组. 我国视网膜病玻璃体腔注药术质量控制标准[J]. 中华眼科杂志, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.Fundus Ophthalmology Group, Ophthalmology Branch of Chinese Medical Association. Quality control standards for intravitreal injection of retinopathy in my country[J]. Chin J Ophthalmol, 2015, 51(12): 892-895. DOI: 10.3760/cma.j.issn.0412-4081.2015.12.005.
5. Bhatt SS, Stepien KE, Joshi K. Prophylactic antibiotic use after intravitreal injection: effect on endophthalmitis rate[J]. Retina, 2011, 31(10): 2032-2036. DOI: 10.1097/IAE.0b013e31820f4b4f.
6. Benoist d'Azy C, Pereira B, Naughton G, et al. Antibioprophylaxis in prevention of endophthalmitis in intravitreal injection: a systematic review and meta-analysis[J/OL]. PLoS One, 2016, 11(6): e0156431[2016-06-03]. https://pubmed.ncbi.nlm.nih.gov/27257676/. DOI: 10.1371/journal.pone.0156431.
7. Bande MF, Mansilla R, Pata MP, et al. Intravitreal injections of anti-VEGF agents and antibiotic prophylaxis for endophthalmitis: a systematic review and meta-analysis[J/OL]. Sci Rep, 2017, 7(1): 18088[2017-12-22]. https://pubmed.ncbi.nlm.nih.gov/29273773/. DOI: 10.1038/s41598-017-18412-9.
8. Menchini F, Toneatto G, Miele A, et al. Antibiotic prophylaxis for preventing endophthalmitis after intravitreal injection: a systematic review[J]. Eye (Lond), 2018, 32(9): 1423-1431. DOI: 10.1038/s41433-018-0138-8.
9. Merani R, Hunyor AP. Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review[J/OL]. Int J Retina Vitreous, 2015, 1: 9[2015-07-21]. https://pubmed.ncbi.nlm.nih.gov/27847602/. DOI: 10.1186/s40942-015-0010-y.
10. Yin VT, Weisbrod DJ, Eng KT, et al. Antibiotic resistance of ocular surface flora with repeated use of a topical antibiotic after intravitreal injection[J]. JAMA Ophthalmol, 2013, 131(4): 456-461. DOI: 10.1001/jamaophthalmol.2013.2379.
11. hrestha R, Karki P, Joshi SN. Outcome of intravitreal bevacizumab injection without pre and postoperative antibiotics[J/OL]. BMC Ophthalmol, 2020, 20(1): 145[2020-04-15]. https://pubmed.ncbi.nlm.nih.gov/32293351/. DOI: 10.1186/s12886-020-01420-1.
12. Miño De Kaspar H, Hoepfner AS, Engelbert M, et al. Antibiotic resistance pattern and visual outcome in experimentally-induced Staphylococcus epidermidis endophthalmitis in a rabbit model[J]. Ophthalmology, 2001, 108(3): 470-478. DOI: 10.1016/s0161-6420(00)00545-5.
13. Stem MS, Rao P, Lee IJ, et al. Predictors of endophthalmitis after intravitreal injection: a multivariable analysis based on injection protocol and povidone iodine strength[J]. Ophthalmol Retina, 2019, 3(1): 3-7. DOI: 10.1016/j.oret.2018.09.013.
14. Grzybowski A, Told R, Sacu S, et al. 2018 update on intravitreal injections: euretina expert consensus recommendations[J]. Ophthalmologica, 2018, 239(4): 181-193. DOI: 10.1159/000486145.
15. Ferguson AW, Scott JA, McGavigan J, et al. Comparison of 5% povidone-iodine solution against 1% povidone-iodine solution in preoperative cataract surgery antisepsis: a prospective randomised double blind study[J]. Br J Ophthalmol, 2003, 87(2): 163-167. DOI: 10.1136/bjo.87.2.163.
16. Musumeci R, Troiano P, Martinelli M, et al. Effectiveness of 0.66% povidone-iodine eye drops on ocular surface flora before cataract surgery: a nationwide microbiological study[J/OL]. J Clin Med, 2021, 10(10): 2198[2019-05-19]. https://pubmed.ncbi.nlm.nih.gov/34069600/. DOI: 10.3390/jcm10102198.
17. Koerner J, Grzybowski A. Povidone-iodine pharmacokinetics and study design[J/OL]. BMC Ophthalmol, 2020, 20(1): 29[2020-01-17]. https://pubmed.ncbi.nlm.nih.gov/31952486/. DOI: 10.1186/s12886-020-1313-9.
18. Jiang J, Wu M, Shen T. The toxic effect of different concentrations of povidone iodine on the rabbit's cornea[J]. Cutan Ocul Toxicol, 2009, 28(3): 119-124. DOI: 10.1080/15569520903080511.
19. Simonett JM, Igelman A, Taylor SC, et al. Culture-proven endophthalmitis after intravitreal injection: a 10-year analysis[J]. Ophthalmic Surg Lasers Imaging Retina, 2019, 50(1): 33-38. DOI: 10.3928/23258160-20181212-05.
20. Labardini CP, Blumenthal EZ. Causative pathogens in endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents[J]. Rambam Maimonides Med J, 2018, 9(4): 1-6. DOI: 10.5041/RMMJ.10348.
21. Writing committee for the Post-Injection Endophthalmitis Study Group, Patel SN, Tang PH, et al. The influence of universal face mask use on endophthalmitis risk after intravitreal anti-vascular endothelial growth factor injections[J/OL]. Ophthalmology, 2021[2021-05-18]. https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(21)00368-7. DOI: 10.1016/j.ophtha.2021.05.010. [published online ahead of print].
22. Chen Y, Wei W, Vavvas DG, et al. Incidence of endophthalmitis after intravitreal anti-vascular endothelial growth factor injections in an operating room in China[J/OL]. J Ophthalmol, 2020, 2020: 5163484[2020-11-12]. https://pubmed.ncbi.nlm.nih.gov/33815833/. DOI: 10.1155/2020/5163484.
23. Shaheen F, Awan MA, Hafeez A, et al. Incidence of endophthalmitis following intravitreal anti VEGF injections at a tertiary care hospital in Pakistan[J]. J Pak Med Assoc, 2021, 71(4): 1184-1188. DOI: 10.47391/JPMA.212.
24. Kiss S, Dugel PU, Khanani AM, et al. Endophthalmitis rates among patients receiving intravitreal anti-VEGF injections: a USA claims analysis[J]. Clin Ophthalmol, 2018, 12: 1625-1635. DOI: 10.2147/OPTH.S169143.
25. VanderBeek BL, Bonaffini SG, Ma L. The association between intravitreal steroids and post-injection endophthalmitis rates[J]. Ophthalmology, 2015, 122(11): 2311-2315.e1. DOI: 10.1016/j.ophtha.2015.07.005.
26. Abu-Yaghi NE, Shokry AN, Abu-Sbeit RH. Bilateral same-session intravitreal injections of anti-vascular endothelial growth factors[J]. Int J Ophthalmol, 2014, 7(6): 1017-1021. DOI: 10.3980/j.issn.2222-3959.2014.06.20.

Chinese Journal of Ocular Fundus Diseases

Specification of intravitreal injections procedures to reduce the incidence of endophthalmitis

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