Endophthalmitis following intravitreal injection of anti-vascular endothelial growth factor agents

Although intravitreal injections of anti-vascular endothelial growth factor medications are generally safe and effective, endophthalmitis remains a rare but potentially devastating complication. This review evaluates recent evidence for prophylactic strategies to prevent postinjection endophthalmitis. Povidone-iodine applied to the ocular surface before injection remains the most effective technique to prevent infection although aqueous chlorhexidine may be an acceptable alternative. Minimizing oral flora exposure, particularly with a no-talking policy, has been shown to reduce endophthalmitis rates. Recent studies of prefilled syringes suggest that the technology significantly lowers the risk of injection, likely by eliminating the transfer of medication from a storage vial to a syringe. Avoiding lid or lash touch during the injection process is an important tool to decrease patient risk, although this may be accomplished with manual lid retraction rather than a lid speculum. Same-day bilateral intravitreal injections have been shown to be safe. Several other strategies have not shown efficacy. The use of drapes or gloves, the clinical setting of injection administration, and ocular location of injection do not appear to affect infection rates. Topical prophylactic antibiotics do not reduce the risk of endophthalmitis and should not be routinely used.