povidone-iodine and Wet-Macular-Degeneration

To report conjunctival bacterial flora antibiotic resistance patterns after serial intravitreal injections performed using a povidone-iodine preparation without the use of preinjection or postinjection topical antibiotics.. Prospective, interventional case series.. Single-center clinical practice in Pennsylvania.. Thirteen eyes of 13 treatment-naïve patients undergoing serial intravitreal anti-vascular endothelial growth factor (VEGF) injections for exudative age-related macular degeneration or macular edema attributable to retinal vein occlusion.. Conjunctival cultures from the treatment eye were performed prior to each injection preparation. A minimum of 3 monthly conjunctival cultures were obtained per eye over the course of the study. Ocular surface preparation consisted of topical anesthetic and povidone-iodine 5% without the use of preinjection or postinjection topical antibiotics.. Conjunctival flora growth patterns and antibiotic resistance patterns to several common antibiotics tested over the course of the study.. A total of 48 cultures were performed with a 77% culture positivity rate. Over the course of the serial conjunctival cultures in each patient, there was no evidence for emergence of resistant bacteria to any of the tested antibiotics (including fluoroquinolones and azithromycin) or significant alteration from baseline conjunctival flora. Of the 47 bacterial isolates, the most commonly isolated organism was coagulase-negative Staphylococcus both at baseline (73%) and following serial intravitreal injections (78%, P = .73).. Ocular surface preparation for intravitreal injection using povidone-iodine 5% alone in the absence of postinjection topical antibiotics does not appear to promote bacterial resistance or a discernible change in conjunctival flora.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Angiogenesis Inhibitors; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bacteria; Conjunctiva; Drug Resistance, Bacterial; Endophthalmitis; Female; Humans; Intravitreal Injections; Macular Edema; Male; Microbial Sensitivity Tests; Middle Aged; Povidone-Iodine; Prospective Studies; Vascular Endothelial Growth Factor A; Wet Macular Degeneration

To establish the conjunctival sac bacterial flora structure in patients with wet form of the age-related macular degeneration (ARMD) indicated for the intravitreal application of Ranibizumab (Lucentis, Novartis Pharma AG). To evaluate the efficacy of combined local preparation with broad-spectrum antibiotic moxifloxacine 0.5% (Vigamox, Alcon) and povidone iodine solution, 5% (Betadine, Egis Pharmaceuticals, LTD.) and to evaluate subjective toleration of moxifloxacin.. In a prospective, non-randomized study were evaluated 20 eyes of 20 patients treated by means of intravitreally-applied ranibizumab. In all patients, the swabs from the conjunctival sac of the treated eye were repeatedly taken in a given time-schedule--before the start of using moxifloxacin, on the day of the intravitreal application of ranibizumab--before the irrigation of the conjunctival sac with povidone iodine solution, 5%, further after the irrigation--immediately before the injection and the control was token three days after the intravitreal injection. At the same time, the moxifloxacine toleration was evaluated by a questionnaire.. The samples taken from the conjunctival sac of the treated eye before the application of moxifloxacine had positive bacterial culture in 17 eyes (85%) and negative culture in 3 eyes (15 %). Furthermore, in 2 eyes with positive culture, there was established resistance to moxifloxacine. After 3 days of moxifloxacine application, there was negative culture in 13 eyes (65%), in 7 eyes (35%) was the bacterial cultivation positive. After the irrigation with povidone iodine 5% solution was the cultivation negative in 17 eyes (85%), positive cultivation was in 3 eyes (15%); in all three cases, the cultures were susceptible to moxifloxacine. Three days after the intravitreal injection, the negative cultivation from the conjunctival sac was found in 13 eyes (65%), and in 7 eyes was the cultivation positive; the cultivated bacteria were moxifloxacine susceptible. Subjective symptoms after moxifloxacine application were reported by 10 patients altogether; 5 patients were without symptoms and 5 patients did not return the questionnaire. On average, the symptoms started the second day of moxifloxacine treatment and the average grade of symptoms was 1.6 on the scale from 0 to 5.. In our group we found a broad spectrum of microorganisms colonizing the conjunctival sac of patients indicated to the ARMD intravitreal treatment. After the prophylaxis with moxifloxacine, the incidence of positive bacterial cultivation decreased and the povidone iodine 5% solution irrigation this effect increased. The most common pathogen species was Staphylococcus coagulasis negative. Although the resistance to moxifloxacine in two different bacteria in two eyes in the beginning of observation was established, after moxifloxacine treatment, the cultivation of these bacteria in both eyes was negative, and in all other cases the cultivated bacteria were susceptible to moxifloxacine.

Topics: Aged; Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Aza Compounds; Bacteria; Conjunctiva; Drug Combinations; Drug Resistance, Bacterial; Female; Fluoroquinolones; Humans; Intravitreal Injections; Male; Moxifloxacin; Povidone-Iodine; Quinolines; Ranibizumab; Wet Macular Degeneration