Intravitreal injection guidelines compatible with practice patterns in anterior segment surgery

Endophthalmitis remains one of the most feared complications after any surgical procedure that enters the eye, and to me, an intravitreal injection is a surgical procedure. It is interesting that our retina colleagues who perform most intravitreal injections have now surpassed their cataract surgeon colleagues in frequency of surgical invasions into the eye per year. In addition, intravitreal injections are growing at a more rapid rate than cataract surgery.Both cataract surgery and intravitreal injections put the patient at risk for infectious and noninfectious endophthalmitis. The risk found in one meta-analysis reported by Colin McCannel, MD, was 52 cases of endophthalmitis in 105,536 injections. Half were culture positive, and half were culture negative. The most common organism was Staphylococcus and second was Streptococcus. This is an incidence of about 1:2,000 injections. This is slightly lower than the incidence in cataract surgery, which approximates 1:1,000 when intraoperative intraocular antibiotics are not used. In addition, the most common organism is the same, Staphylococcus. The likelihood of a streptococcal infection is higher, however, after an intravitreal injection, and a gram-negative rod such as Escherichia coli or Pseudomonas aeruginosa is more common after cataract surgery.