povidone-iodine and Diabetic-Retinopathy

This report provides updated endophthalmitis rates for eyes receiving intravitreous injections with and without povidone-iodine and rates with and without topical antibiotics from Diabetic Retinopathy Clinical Research Network clinical trials.. Among 8 Diabetic Retinopathy Clinical Research Network clinical trials conducted from 2006 to 2015, 28 786 intravitreous injections were administered (3123 eyes), and 20 617 of those (2264 eyes) were administered between 2012 and 2015. Eleven cases of endophthalmitis occurred; 4 occurred between 2012 and 2015. Thirteen injections in 3 eyes from 2 participants were administered without povidone-iodine; both participants developed endophthalmitis in 1 eye. Of the remaining 28 773 injections (3120 eyes) performed with povidone-iodine, 9 cases of endophthalmitis occurred: 6 cases (0.05% of 11 565 injections) in eyes receiving topical antibiotics and 3 cases (0.02% of 17 208 injections) in eyes not receiving topical antibiotics (P = .17).. While only a small number of eyes did not receive povidone-iodine just prior to an intravitreous injection, this report provides further evidence regarding the risk of endophthalmitis when povidone-iodine is not used before intravitreous injections. Exclusion of topical antibiotics was not associated with a higher risk of endophthalmitis. Continued use of povidone-iodine and consideration to eliminate topical antibiotics from injection procedures seems warranted.

Topics: Administration, Topical; Anti-Bacterial Agents; Canada; Diabetic Retinopathy; Endophthalmitis; Humans; Incidence; Intravitreal Injections; Povidone-Iodine; Prognosis; Retrospective Studies; United States

To assess whether meibomian glands and ocular surface parameters are affected by repeated topical povidone-iodine and antibiotic applications in patients with repeated intravitreal injections.. Forty-five patients with at least three previous intravitreal injections and 28 healthy controls were included in the study. In the injection group, 21 patients had age-related macular degeneration and 24 patients had diabetic macular edema. For each participant, infrared meibography for the upper and lower eyelids and noninvasive tear break-up time calculation were performed with a corneal topographer. Fluorescein tear break-up time and ocular surface disease index (OSDI) scores were also obtained. Noninvasive tear break-up time, fluorescein tear break-up time, and OSDI scores were recorded for each participant and compared between the injection and control groups. These parameters were also compared as a subgroup analysis between patients with age-related macular degeneration (AMD) and diabetic macular edema (DME).. Upper lid meibomian gland loss, lower lid meibomian gland loss ratios, and OSDI scores were significantly higher in the intravitreal injection group compared with the control group (P=0.004, P<0.001, P<0.001, respectively). Fluorescein tear break-up time and noninvasive tear break-up time were significantly lower in the intravitreal injection group compared with the control group (P<0.001, P<0.001). There was no significant difference between the AMD and DME groups for these parameters.. This study showed for the first time that meibomian gland losses were significantly increased by repeated povidone-iodine and antibiotic applications in patients with repeated intravitreal injections. Ocular surface parameters were altered with higher ocular surface symptoms in those patients.

Topics: Anti-Bacterial Agents; Diabetic Retinopathy; Dry Eye Syndromes; Humans; Intravitreal Injections; Macular Edema; Meibomian Glands; Povidone; Povidone-Iodine; Tears

The purpose was to evaluate the change in the microbiological profile of diabetic patients undergoing intravitreal injections for diabetic macular edema.. Patients were included in this prospective study when referred for the first time for intravitreal injection to treat diabetic macular edema. For each patient, conjunctival cultures were taken from the lower fornix of each eye prior to the povidone-iodine application and the intravitreal injection. An additional culture was taken from the treated eye 20 min after the injection. The same culture protocol was used for the two following injections of these patients. A later conjunctival culture was also taken a month after the last injection.. Twenty-one eyes of 21 patients were included. The mean duration of diabetes was 13.7 ± 7.9 years. Prior to the first intravitreal injection, 33% of cultures were positive. Prior to the third intravitreal injection, 26% of cultures were positive (. Repeated intravitreal injection for diabetic macular edema with application of povidone-iodine 5% in diabetic patients did not lead to a significant change in the percentage of positive conjunctival cultures. Patients with higher HbA1C had a slight, non-statistically significant trend for positive cultures.

Topics: Aged; Angiogenesis Inhibitors; Anti-Infective Agents, Local; Bacteria; Conjunctiva; Diabetic Retinopathy; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Intravitreal Injections; Macular Edema; Male; Ophthalmic Solutions; Povidone-Iodine; Prospective Studies

To determine the incidence of bacterial contamination of needles used for intravitreal injections.. Patients undergoing intravitreal injections were enrolled prospectively. No pre-injection antibiotics were administered. Following povidone-iodine irrigation, conjunctival cultures were taken and the injection was performed. The needle was cultured. A dry control needle was exposed to the surgical field and cultured.. No patients developed endophthalmitis. Eighteen injection needles (18%) yielded positive bacterial growth. The most commonly encountered organisms were Propionibacterium acnes (n = 8) and Staphylococcus epidermidis (n = 6). Four control needles showed positive growth, in 2 cases with the same organism as a matching positive used needle. The difference between contamination rates of used and control needles was significant (p = .002, McNemar's test).. Bacterial contaminants are present on a substantial proportion of needles. Since the needle contacts both the ocular surface and the vitreous, it is possible that inoculation of the vitreous cavity occurs in such cases.

Topics: Adult; Aged; Aged, 80 and over; Angiogenesis Inhibitors; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Bevacizumab; Choroidal Neovascularization; Cross-Sectional Studies; Diabetic Retinopathy; Endophthalmitis; Equipment Contamination; Eye Infections, Bacterial; Female; Humans; Intravitreal Injections; Macular Degeneration; Male; Middle Aged; Needles; Povidone-Iodine; Propionibacterium acnes; Prospective Studies; Ranibizumab; Staphylococcus epidermidis; Vitreous Body