povidone-iodine and Retinal-Diseases

To investigate the bacterial growth in the surgical face masks used by patients who received intravitreal injections and study the effect of povidone-iodine on the periocular area (PA) of masks.. Forty patients who attended for intravitreal injections were divided in those with less (<4 hours) and more (>4 hours) than 4 hours of mask use. Each group was divided depending on the application or not of povidone-iodine in the PA of the mask. Bacterial load was studied on PA and mouth area samples.. The bacterial load in the PA was higher in the >4 hours group compared with the <4 hours group (13.2 vs. 48.75 colony-forming units/μL; P = 0.03). The contamination in the PA significantly decreased after applying povidone-iodine in the >4 hours group (P = 0.01). The use or not of povidone-iodine was strongly correlated to a positive culture (OR = 9.0, P = 0.00. CI 1.63-49.44).. Surgical face masks worn for more than 4 hours present higher contamination in the PA than those with less use. Bacterial load in the PA is reduced with povidone-iodine on masks used for more than 4 hours. This contamination should be considered in the asepsis protocol of intravitreal injections.

Topics: Aged; Aged, 80 and over; Angiogenesis Inhibitors; Anti-Infective Agents, Local; Bacteria; Bacterial Load; Bacteriological Techniques; COVID-19; Equipment Contamination; Female; Humans; Intravitreal Injections; Male; Masks; Middle Aged; Povidone-Iodine; Prospective Studies; Retinal Diseases; SARS-CoV-2; Vascular Endothelial Growth Factor A

To determine the incidence of endophthalmitis after anti-vascular endothelial growth factor (VEGF) therapy at our institution and to identify potential risk factors for endophthalmitis occurring after injection.. Retrospective, single-center cohort study.. All patients who received an intravitreal injection of an anti-VEGF medication between January 1, 2014, and March 31, 2017.. Current Procedural Terminology and International Classification of Diseases billing codes were used to identify instances of anti-VEGF administration and cases of endophthalmitis. Medical records and injection technique were reviewed carefully in each case. Multivariable logistic regression analysis was performed in a stepwise fashion to determine independent predictors of endophthalmitis based on injection protocol.. Incidence of endophthalmitis after injection and odds of endophthalmitis by injection technique with 95% confidence intervals (CIs).. A total of 154 198 anti-VEGF injections were performed during the period of interest, resulting in 58 cases of endophthalmitis (0.038% [1:2659]). After adjustment for confounders, both 2% lidocaine jelly (odds ratio [OR], 11.28; 95% CI, 3.39-37.46; P < 0.001) and 0.5% Tetravisc (Ocusoft, Richmond, TX; OR, 3.95; 95% CI, 1.15-13.50; P = 0.03) use were independent risk factors for endophthalmitis after injection. Lid speculum use, povidone iodine strength (5% vs. 10%), injection location (superior or inferior), conjunctival displacement, use of provider gloves, use of a strict no-talking policy, use of subconjunctival lidocaine, and topical antibiotic use were not statistically significant predictors of endophthalmitis after injection. There was no difference in endophthalmitis rate among the anti-VEGF agents (bevacizumab, ranibizumab 0.3 mg, ranibizumab 0.5 mg, and aflibercept).. The incidence of endophthalmitis after anti-VEGF injections is low. Use of lidocaine jelly or Tetravisc may increase the risk of endophthalmitis after injection.

Topics: Adult; Angiogenesis Inhibitors; Bevacizumab; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Incidence; Intravitreal Injections; Male; Middle Aged; Povidone-Iodine; Ranibizumab; Retinal Diseases; Retrospective Studies; Risk Factors; Vascular Endothelial Growth Factor A

To report the incidence, clinical features, microbiologic culture results, management and visual outcome of patients with endophthalmitis after intravitreal injections (IVTs).. This retrospective chart review included all patients receiving IVTs between January 2005 and July 2012. Cases of suspected and confirmed endophthalmitis after IVT were identified and reviewed.. A total of 20,179 IVTs were perfomed during the study period. Six cases of supected endophthalmitis were identified clinically (0.03%), of which 3 were culture positive (0.015%). The risk of culture-positive post-IVT endophthalmitis was 2/8,882 (0.023%) in the 2005 to 2008 period and 1/11,297 (0.009%) in the period 2009 to 2012. Symptoms developed within the first 3 days after IVT in 4 of the 6 patients and visual acuity was reduced to hand motion in 4 of the 6 patients. Microbiologic specimens were positive on 3 of the 6 cases (coagulase-negative Staphylococcus, n = 2; Staphylococcus aureus, n = 1). Mean visual acuity before patients with endophthalmitis was 20/100, whereas mean final visual acuity at last follow-up was 20/200.. The incidence of endophthalmitis after IVT was low with no cases because of Streptococcus species in the present setting using povidone-iodine in the preoperative disinfection of the conjunctival sac. Therefore, adherence to standardized protocols including the use of povidone-iodine when performing IVTs is recommended.

Topics: Aged; Aged, 80 and over; Angiogenesis Inhibitors; Anti-Infective Agents, Local; Endophthalmitis; Eye Infections, Bacterial; Female; Germany; Humans; Incidence; Intravitreal Injections; Male; Middle Aged; Povidone-Iodine; Referral and Consultation; Retinal Diseases; Retrospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Tertiary Care Centers; Visual Acuity

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.. 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.. 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.. 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.

Topics: Angiogenesis Inhibitors; Anti-Bacterial Agents; Anti-Infective Agents, Local; Denmark; Endophthalmitis; Eye Infections, Bacterial; Humans; Intravitreal Injections; Operating Rooms; Povidone-Iodine; Practice Patterns, Physicians'; Respiratory Protective Devices; Retinal Diseases; Tobramycin; Vascular Endothelial Growth Factor A