Intravitreal injections for macular degeneration, diabetic macular edema, and other conditions are becoming more and more common. The risk of endophthalmitis, or infection in the eye, is the most concerning ocular risk of these injections. Recently, vitreoretinal surgeons have been changing their minds about antibiotics before, during, and after intravitreal injections and many patients have questions about the sudden change.
When intravitreal injections first began for macular degneration, they were a newer procedure. We had done a few before for various conditions, but never before in the quantity and regularity we are doing them now. For many intraocular procedures such as cataract surgery, glacuoma surgery, or even retinal surgery, post-operative antibiotic drops are recommended. So, we routinely used them after intravitreal injection.
In 2011, an ARVO poster from Bascom Palmer showed that with merely providone-iodide pre and post injection, and no post-operative antibiotic drops, there was no greater risk of post-injection infection (1). An article was then published showing routine use of post-injection antibiotics selects resistant bacteria (2).
Subsequently, in 2012, a large study of 15,895 patients was published that showed infeciton rates by Cheung, et al 5 in 8259 for patients who were given antibiotics for 5 days after injection, 2 in 2370 for those who received antibiotics immediately after each injection, and 2 in 5266 who received no antibiotics. There was no statistically significant difference amongst the groups. Several smaller studies have all confirmed that the risk remains about 1 in 1000 to 1 in 5000 patients that get an infection after intravitreal injection.
In light of all of the data showing no benefit to antibiotic drops after injection, and data suggesting maybe a negative effect of antibiotic drops after injection, many retina specialists have stopped using them post injection.
If you have any signs of infection after your injection such as decreasing vision, increasing eye pain, or redness or swelling of the eye or eyelid, you should contact your eye physician.
This is not intended to be medical advice and is for informational purposes only. Please consult a qualified eye care professional if you have questions or concerns.
1. Rumya R. Rao, Golnaz Javey, Philip J. Rosenfeld, William J. Feue. Elimination of Post-Injection Topical Antibiotics after Intravitreal Injections. ARVO May, 2011
2. Kim SJ, Toma HS. Ophthalmic antibiotics and antimicrobial resistance a randomized, controlled study of patients undergoing intravitreal injections.Ophthalmology. 2011 Jul;118(7):1358-63. Epub 2011 Mar 21.
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