No Cases of Endophthalmitis After 20,293 Intravitreal Injections in an Operating Room Setting

In Brief Background: Intravitreal injection has become a common procedure worldwide. A rare, but sight threatening, complication is bacterial endophthalmitis that has a poor visual prognosis. To identify practices that minimize the risk of endophthalmitis, the setting of a Danish University hospital is described. Methods: A review of the intravitreal injection database of the department. All injections were performed in a positive pressure ventilated operating room under sterile conditions. The treating physicians wore face mask, the conjunctiva was irrigated twice with 5% povidone–iodine preoperatively, and topical tobramycin was applied immediately after the injection. Results: The authors have performed a total of 20,293 injections were performed in 2,575 eyes. No cases of proven or suspected endophthalmitis were identified corresponding to a risk of 0% (95% confidence interval, 0–0.019) per injection and 0% (95% confidence interval, 0–0.15%) per patient. Approximately 7,000 injections, all in patients without diabetes, were treated without a course of topical antibiotics after the injection. Conclusion: The department has had the lowest rate of endophthalmitis after intravitreal injections in the current literature. Several factors that could have contributed to the positive result are highlighted. Omitting a postoperative course of topical antibiotic appears safe in patients without diabetes. The authors' department has, to their knowledge, had the lowest rate of endophthalmitis after intravitreal injections in the current literature, and they highlight several factors that could have contributed to the authors' positive results. Omitting a postoperative course of topical antibiotic appeared safe in patients without diabetes.