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Peden, Marc C., MD; Hammer, Mark E., MD; Suñer, Ivan J., MD

doi: 10.1097/IAE.0000000000002290
Original Study: PDF Only

Purpose: To report the rates of postintravitreal injection (IVT) endophthalmitis with topical conjunctival application of various concentrations of povidone-iodine (PI), including no PI.

Methods: Retrospective chart review of patients receiving IVTs performed in a single practice between January 2011 and June 2016. Concentration of PI for all injections was recorded and cases of endophthalmitis identified and reviewed.

Results: A total of 35,060 IVTs in 1854 patients were included from the 5.5-year period. 29,281 injections were performed with standard 5% PI, 5,460 injections with diluted PI (3,731 with 2.5%, 1,673 with 1.25%, 56 with 0.625%), and 319 IVTs with no PI. Incidence of patient-reported PI sensitivity occurred in 15.9% of patients. Fourteen cases of endophthalmitis were identified: 12 in eyes that received 5% PI, one in an eye that received 1.25% PI, and one in an eye receiving no PI. The incidence of endophthalmitis was 0.04% for 5% PI, 0.02% for dilute PI, and 0.31% for no PI prophylaxis. All cases underwent prompt vitrectomy and had positive cultures for coagulase-negative Staphylococcus.

Conclusion: Application of dilute PI solution to the conjunctiva at the time of IVT is an effective alternative to 5% PI for endophthalmitis prophylaxis in betadine-sensitive patients.

Endophthalmitis after intravitreal injection is rare when povidone-iodine antisepsis is used and incidence increases dramatically when withheld. The results herein suggest that dilute povidone-iodine is effective in preventing endophthalmitis and demonstrated a nonstatistically significant trend toward improved germicidal activity compared with the 5% standard, corroborating in vitro data.

Retina Associates of Florida, LLC, Tampa, Florida.

Reprint requests: Marc C. Peden, MD, Retina Associates of Florida, LLC, 602 S. MacDill Avenue, Tampa, FL 33609; e-mail:

Presented in part at the American Society of Retina Specialists Annual Meeting, Boston, MA, August 13, 2017.

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

© 2019 by Ophthalmic Communications Society, Inc.