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Elimination of Topical Antibiotics for Intravitreous Injections and the Importance of Using Povidone-Iodine: Update From the Diabetic Retinopathy Clinical Research Network.

Importance
This report provides updated endophthalmitis rates for eyes receiving intravitreous injections with and without povidone-iodine and rates with and without topical antibiotics from Diabetic Retinopathy Clinical Research Network clinical trials.


Observations
Among 8 Diabetic Retinopathy Clinical Research Network clinical trials conducted from 2006 to 2015, 28 786 intravitreous injections were administered (3123 eyes), and 20 617 of those (2264 eyes) were administered between 2012 and 2015. Eleven cases of endophthalmitis occurred; 4 occurred between 2012 and 2015. Thirteen injections in 3 eyes from 2 participants were administered without povidone-iodine; both participants developed endophthalmitis in 1 eye. Of the remaining 28 773 injections (3120 eyes) performed with povidone-iodine, 9 cases of endophthalmitis occurred: 6 cases (0.05% of 11 565 injections) in eyes receiving topical antibiotics and 3 cases (0.02% of 17 208 injections) in eyes not receiving topical antibiotics (P = .17).


Conclusions and Relevance
While only a small number of eyes did not receive povidone-iodine just prior to an intravitreous injection, this report provides further evidence regarding the risk of endophthalmitis when povidone-iodine is not used before intravitreous injections. Exclusion of topical antibiotics was not associated with a higher risk of endophthalmitis. Continued use of povidone-iodine and consideration to eliminate topical antibiotics from injection procedures seems warranted.