Antibiotics After Intravitreal Injection: Needed or Not?

Hemang K. Pandya, MD; Sophie J. Bakri, MD


March 28, 2013

Incidence of Endophthalmitis and Use of Antibiotic Prophylaxis After Intravitreal Injections

Cheung CS, Wong AW, Lui A, Kertes PJ, Devenyi RG, Lam WC
Ophthalmology. 2012;119:1609-1614

Study Summary

The use of intravitreal pharmacologic agents in treating posterior segment disease has become increasingly common. Endophthalmitis is a rare but severe complication of this procedure. Cheung and colleagues present a retrospective review of post-intravitreal injection endophthalmitis in association with 3 different antibiotic prophylaxis strategies:

Antibiotics given immediately after each injection;

Antibiotics given for 5 days after each injection; or

No antibiotics.

This study reviewed 15,895 intravitreal injections (9453 ranibizumab, 5386 bevacizumab, 935 triamcinolone, and 121 pegaptanib) that were performed for various indications over a 5-year period. Of the 9 eyes (0.057%) that developed suspected endophthalmitis, 3 (0.019%) were culture-positive (Streptococcus viridans, Streptococcus mitis, and Enterococcus faecalis) and 6 (0.038%) were culture-negative.

In patients who received antibiotics immediately after the injection, the rate of endophthalmitis was 2 in 2370 injections (0.084%). In patients who received antibiotics for 5 days following the injection, the rate of endophthalmitis was 5 in 8259 injections (0.061%). Both of these antibiotic prophylaxis groups had higher rates of endophthalmitis than those who did not receive postinjection antibiotics (2 in 5266 injections; 0.038%).

This study shows that the overall rate of intravitreal injection-related endophthalmitis is higher with the use of topical antibiotics, given immediately or for 5 days following injection, compared with no antibiotics. However, because of the low incidence of endophthalmitis in this study, it was not powered adequately to determine the differences in endophthalmitis rates in relation to different antibiotic strategies.


This study has significance for current clinical practice, because it suggests that the use of topical antibiotics after intravitreal injections may be unnecessary. This conclusion has both patient safety and financial implications. Prospective multicenter studies with patient randomization may shed further light on this finding.