Preventive factors, diagnosis, and management of injection-related endophthalmitis: a literature review.

Abstract

BACKGROUND:

Intravitreal medication injections represent the gold standard treatment for a variety of potentially blinding chorioretinal vascular diseases. Despite their excellent safety profile, they are associated with the feared complication of injection-related endophthalmitis (IRE). Though the overall incidence of IRE is low, due to the ever-increasing number of injections being performed, it is a complication that all retina specialists are likely to encounter. This article reviews various factors that could potentially influence the risk of IRE and discusses evidence-based strategies for management.

METHOD:

PubMed was searched for keywords "intravitreal injection" and "endophthalmitis" from the period of 1995-2021. Relevant articles were reviewed and selected articles were analyzed with respect to the incidence, potential preventive factors, clinical presentation, microbial profile, management, and outcomes for IRE.

RESULTS:

There is strong consensus supporting the use of povidone iodine topical antiseptic, eyelid retraction away from the injection site, and avoiding treatment of eyes with active surface or eyelid disease, but there is less agreement on the use of face masks versus "no-talking" policies and optimal anesthetic technique. Current evidence comparing tap and inject or early vitrectomy for treatment of IRE is inadequate to determine an optimal treatment strategy.

CONCLUSION:

Intravitreal injections are sight saving, but even using established prophylactic measures there remains a small but real risk of infectious injection-related complications. Further investigations comparing tap and inject versus vitrectomy may help to establish optimal treatment, although the rarity of IRE makes designing adequately powered prospective trials a difficult task.

• Authors: Rupali Singh, Samaneh Davoudi, Steven Ness
• Journal: Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie (Graefes Arch Clin Exp Ophthalmol) Vol. 260 Issue 8 Pg. 2399-2416 (Aug 2022) ISSN: 1435-702X [Electronic] Germany
• PMID: 35278125 (Publication Type: Journal Article, Review)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Chemical References

• Angiogenesis Inhibitors
• Anti-Bacterial Agents
• Vascular Endothelial Growth Factor A
• Ranibizumab

Topics

• Angiogenesis Inhibitors
• Anti-Bacterial Agents (therapeutic use)
• Endophthalmitis (diagnosis, epidemiology, etiology)
• Eye Infections, Bacterial (diagnosis, epidemiology, etiology)
• Humans
• Incidence
• Intravitreal Injections
• Prospective Studies
• Ranibizumab
• Retrospective Studies
• Vascular Endothelial Growth Factor A