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Role of Prophylactic Topical Ophthalmic Antibiotics

Li, Alexa L. BS; Wykoff, Charles C. MD, PhD; Wang, Rui BA; Chen, Eric MD; Benz, Matthew S. MD; Fish, Richard H. MD; Wong, Tien P. MD; Major, James C. Jr MD, PhD; Brown, David M. MD; Schefler, Amy C. MD; Kim, Rosa Y. MD; O'Malley, Ronan E. MD

doi: 10.1097/IAE.0000000000000901
Original Study

Purpose: To determine the rate of postintravitreal injection endophthalmitis and to assess microbiological features and outcomes with and without the use of peri-intravitreal injection topical ophthalmic antibiotics.

Methods: Consecutive series of endophthalmitis cases retrospectively identified after intravitreal injection at a multicenter, retina-only referral practice (Retina Consultants of Houston) from January 1, 2011 to December 31, 2014. Prophylactic peri-intravitreal injection topical antibiotics were routinely used during the initial 12-month period (January 1, 2011–December 31, 2011) and not used in the final 24-month period (January 1, 2013–December 31, 2014). Main outcome measures were incidence of endophthalmitis, microbiology results, treatment strategies, and visual outcomes.

Results: Of 90,339 intravitreal injections, 30 cases of endophthalmitis were identified (endophthalmitis rate = 0.033%; 95% confidence interval, 0.021–0.045%; or approximately 1 of 3,011 intravitreal injections). The most common organisms isolated were coagulase-negative staphylococci (n = 10, 33%), followed by Streptococcus mitis (n = 2, 7%). Fourteen cases (47%) were culture negative. Peri-intravitreal injection topical antibiotic prophylaxis did not decrease the rate of endophthalmitis (0.035% [95% CI, 0.007–0.064%] with antibiotic use versus 0.021% [95% CI, 0.008–0.033%] without antibiotic use; P = 0.261).

Conclusion: The risk of endophthalmitis after intravitreal injection remains low, with coagulase-negative staphylococci and Streptococcus mitis the most common bacterial isolates identified. Prophylactic peri-intravitreal injection topical ophthalmic antibiotic use did not decrease the endophthalmitis rate.

In this consecutive case series of 90,339 intravitreal injections from a large, office-based retina practice, the rate of postinjection clinically suspected endophthalmitis was 0.033%, and the most common microbiological isolates were staphylococcal and streptococcal species. Prophylactic peri-intravitreal injection topical ophthalmic antibiotic use did not affect the rate of endophthalmitis.

*Retina Consultants of Houston, Houston, Texas; and

Blanton Eye Institute and Houston Methodist Hospital, Houston, Texas.

Reprint requests: Charles C. Wykoff, MD, PhD, 6560 Fannin Street, Suite 750, Houston, TX 77030; e-mail:

None of the authors have any financial/conflicting interests to disclose.

© 2016 by Ophthalmic Communications Society, Inc.