Premium
Is there a rational for the use of topical antibiotics before and after intravitreal injections
Author(s) -
LABETOULLE M
Publication year - 2012
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2012.3412.x
Subject(s) - medicine , endophthalmitis , antibiotics , incidence (geometry) , surgery , conjunctiva , retrospective cohort study , aseptic processing , anesthesia , physics , microbiology and biotechnology , pathology , optics , biology
Among the possible complications of intravitreal injections (IVI), postoperative endophthalmitis is the most severe. On the first series, the incidence was between 0.7 and 1.6%. Through improved practices, it was quickly reduced to around 0.09% to 0.03%, according to two recent retrospective series. The guidelines for IVI generally recommend performing the surgery under conditions close to those of the anterior segment surgeries, i.e. in compliance with aseptic conditions. The instillation of antibiotic eye drops was initially recommended, three days before and three days after IVT. Several publications have evolved strategies. Recent studies showed low rates of endophthalmitis despite the lack of preoperative antibiotics and a retrospective study found no significant difference whether or not topical antibiotic therapy was used pre‐and postoperatively. One study showed that instillation of antibiotics before surgery does not contribute to the sterility of the conjunctiva immediately before injection, from the moment the surgical site has been prepared with povidone iodine. It therefore appears that antibiotic treatment in IVIs is essentially aimed at reducing the contamination of the conjunctiva from the immediate post‐op period to the time the site of injection is considered healed. In this respect, the ideal antibiotic should combine several of the following properties: rapid efficiency on bacteria potentially responsible for endophthalmitis, broad spectrum, no lasting change in the conjunctival flora, no selection of resistance to this antibiotic or other antibiotics by crossover mechanism, reusability without additives adverse reactions with repeated cures.