Endophthalmitis Incidence after Intravitreal Injection of Anti-VEGF Agents with Povidone-Iodine versus Aqueous Chlorhexidine Antisepsis.

PURPOSE: To evaluate the incidence of postinjection endophthalmitis (PIE) after intravitreal injection (IVI) of anti-VEGF agents in eyes prepared with topical 5% povidone-iodine (PI) or 0.05% aqueous chlorhexidine (AqCHX) as antisepsis.

DESIGN

Retrospective, single-center, comparative cohort study.

PARTICIPANTS

Individuals who received ≥1 intravitreal anti-VEGF injection with use of PI or AqCHX as antisepsis.

METHODS

For all patients receiving intravitreal anti-VEGF injections at Austin Retina Associates between March 1, 2015 and November 1, 2023, all injections and cases of suspected PIE were identified with billing codes and confirmed with review of electronic medical record data. Eyes that presented after injection with pain or decreased vision warranting treatment with intravitreal antibiotics were considered suspected PIE cases. Eyes were grouped based on preparation with PI or AqCHX.

MAIN OUTCOME MEASURES: The primary outcomes were incidence of suspected and culture-positive PIE and visual acuity (VA) at 3 months postendophthalmitis.

RESULTS

A total of 302 474 IVIs were administered during the study period. Within the PI group, 59 cases of suspected PIE occurred after 267 190 injections (0.022%; 1 in 4529 injections) compared with 5 cases after 35 284 injections (0.014%; 1 in 7057 injections) in the AqCHX group (P = 0.34). For the PI group, there were 10 culture-positive PIE cases (0.0037%, 1 in 26 719 injections) compared with 0 cases in the AqCHX group (P = 0.25). At 3 months postinfection, average VA in the PI group was 0.97 (∼20/200) and 1.4 (∼20/500) in the AqCHX group (P = 0.41). When controlling for prefilled syringe status, there was no difference in rates of PIE between antisepsis groups (P = 0.23).

CONCLUSIONS

The incidence of endophthalmitis after IVI is low, with no difference in the rates of infection with eyes prepared with topical PI compared with AqCHX. Topical AqCHX has similar efficacy to PI for the prevention of endophthalmitis after IVI.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.