Intravitreal Injections and Endophthalmitis

Stephen J. Kim, MD


Int Ophthalmol Clin. 2015;55(2):1-10. 

In This Article

Respiratory Contamination

Streptococcus species, a common component of oral flora, have become increasingly reported as a cause of endophthalmitis presumably from contamination by respiratory droplets. A meta-analysis of the US literature from 2005 to 2009 reported an overall rate of endophthalmitis after IVT injection of 52 in 105,536 injections (0.049%).[24] Among positive culture results, 31% were due to streptococcal species. Talking may result in bacterial dispersal of streptococcal species and wearing a face mask or remaining silent may significantly decrease risk of bacterial contamination.[25] In light of this, measures to reduce potential contamination by restricting talking by the patient and provider during the procedure are reasonable and can be implemented readily. Use of a mask has also been proposed but its benefits remain unproven. A survey of members of the American Society of Retina Specialists in 2012 revealed that only approximately 13% of specialists use a mask during IVT injection. Instead the vast majority of members (63%) strictly avoid talking and ask the patient not to talk during the procedure.