Hiroyuki Shimada & Takayuki Hattori & Ryusaburo Mori &
Hiroyuki Nakashizuka & Kyoko Fujita & Mitsuko Yuzawa
Department of Ophthalmology, School of Medicine, Surugadai
Hospital of Nihon University, 1-8-13 Surugadai, Kanda,
Chiyodaku, Tokyo 101-8309, Japan
e-mail: sshimada@olive.ocn.ne.jp
Abstract
Background To examine the efficacy of complying with an
infection control manual for intravitreal injection of anti-
vascular endothelial growth factor (VEGF) preparations in
reducing the rate of endophthalmitis.
Methods We retrospectively reviewed intravitreal anti-
VEGF injections conducted by vitreoretinal specialists at
the outpatient injection room of a single university hospital
between July 2009 and July 2012. The injections were
conducted following an infection control manual established
by our department. Doctors and nurses wore surgical masks,
and disinfected the patient’s eyelid skin with 10 % povi-
done–iodine and then the conjunctiva with 0.25 % povi-
done–iodine. After putting a drape on the patient’s face, a lid
speculum was placed. The conjunctival surface was again
washed with 5 ml of 0.25 % povidone–iodine. After waiting
at least 30 seconds, intravitreal injection was performed
through povidone–iodine. Following injection, the injection
site was again washed with 5 ml of 0.25 % povidone–
iodine. Patients were treated with topical levofloxacin 4
times a day for 3 days before and after the injection.
Results A total of 15,144 injections comprising 548 injections
of pegaptanib sodium, 846 injections of bevacizumab, and
13,750 injections of ranibizumab were performed. During this
period, no case of suspected or proven infectious endophthal-
mitis occurred. The endophthalmitis rate was 0 per 15,144
injections, (95 % confidence interval, 0.0–0.0 %).
Conclusion The results suggest that endophthalmitis can be
reduced to a minimum by preventing normal flora of the conjunctiva and bacteria in the oral cavity from entering the
vitreous. For this purpose, an infection control manual that
requires nurses and doctors to wear surgical mask and drape
the patient’s face, irrigate the conjunctiva with 0.25 % povi-
done–iodine and wait at least 30 seconds before performing
intravitreal injection is useful.