No cases of endophthalmitis after 20,293 intravitreal injections in an operating room setting.

Background: Intravitreal injection has become a common procedure worldwide. A rare, but sight threatening, complication is bacterial endophthalmitis that has a poor visual prognosis. To identify practices that minimize the risk of endophthalmitis, the setting of a Danish University hospital is described.
Methods: A review of the intravitreal injection database of the department. All injections were performed in a positive pressure ventilated operating room under sterile conditions. The treating physicians wore face mask, the conjunctiva was irrigated twice with 5% povidone-iodine preoperatively, and topical tobramycin was applied immediately after the injection.
Results: The authors have performed a total of 20,293 injections were performed in 2,575 eyes. No cases of proven or suspected endophthalmitis were identified corresponding to a risk of 0% (95% confidence interval, 0-0.019) per injection and 0% (95% confidence interval, 0-0.15%) per patient. Approximately 7,000 injections, all in patients without diabetes, were treated without a course of topical antibiotics after the injection.
Conclusion: The department has had the lowest rate of endophthalmitis after intravitreal injections in the current literature. Several factors that could have contributed to the positive result are highlighted. Omitting a postoperative course of topical antibiotic appears safe in patients without diabetes.