Intravitreal Injections and Endophthalmitis

Stephen J. Kim, MD


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

In This Article


If current trends continue, IVT injections will become the most common cause of endophthalmitis seen in clinical practice. Given the severe consequences of endophthalmitis, its prevention should be a priority. Emphasis should be placed on interventions with minimal risk of adverse reactions and low costs. Consequently, there is no evidence to support the benefit of antibiotics in conjunction with povidone-iodine. In contrast, restricting talking between the patient and provider during the procedure may reduce respiratory contamination by streptococcus species and can be readily implemented at no additional cost. Subconjunctival lidocaine may offer additional benefits at reducing the risk of endophthalmitis, but further studies are needed to confirm this. Although the use of a lid speculum and gloves have been historically emphasized, neither are necessary if patients can comply with instruction and proper handling of the needle and syringe to avoid contamination by the hand or finger tip can be consistently achieved. Finally, periodic review of compounding pharmacy practices and accreditation status is prudent to minimize the risk of future outbreaks.