Minimizing the endophthalmitis rate following intravitreal injections using 0.25 % povidone-iodine irrigation and surgical mask

To examine the efficacy of complying with an infection control manual for intravitreal injection of anti-vascular endothelial growth factor (VEGF) preparations in reducing the rate of endophthalmitis. We retrospectively reviewed intravitreal anti-VEGF injections conducted by vitreoretinal specialists at the outpatient injection room of a single university hospital between July 2009 and July 2012. The injections were conducted following an infection control manual established by our department. Doctors and nurses wore surgical masks, and disinfected the patient's eyelid skin with 10 % povidone-iodine and then the conjunctiva with 0.25 % povidone-iodine. After putting a drape on the patient's face, a lid speculum was placed. The conjunctival surface was again washed with 5 ml of 0.25 % povidone-iodine. After waiting at least 30 seconds, intravitreal injection was performed through povidone-iodine. Following injection, the injection site was again washed with 5 ml of 0.25 % povidone-iodine. Patients were treated with topical levofloxacin 4 times a day for 3 days before and after the injection. A total of 15,144 injections comprising 548 injections of pegaptanib sodium, 846 injections of bevacizumab, and 13,750 injections of ranibizumab were performed. During this period, no case of suspected or proven infectious endophthalmitis occurred. The endophthalmitis rate was 0 per 15,144 injections, (95 % confidence interval, 0.0-0.0 %). The results suggest that endophthalmitis can be reduced to a minimum by preventing normal flora of the conjunctiva and bacteria in the oral cavity from entering the vitreous. For this purpose, an infection control manual that requires nurses and doctors to wear surgical mask and drape the patient's face, irrigate the conjunctiva with 0.25 % povidone-iodine and wait at least 30 seconds before performing intravitreal injection is useful.