Post injection endophthalmitis, technique, professional notes
- Infections Eye 12 "Significant risk factors
- were failure to administer topical antibiotics immediately after the injection (P=0.001),
- blepharitis (P=0.006),
- subconjunctival anaesthesia (P=0.021),
- patient squeezing during the injection (P=0.021), and
- failure to administer topical antibiotics before anti-VEGF injection (P=0.05)."
- Infection is related to eye cleaning rather rather than drapes/gloves see 09. Strep Retina 2011
- must wait 3 minutes after the eye is cleaned.
- Operating theatre ...far fewer infections than an outpatient room, even a clean room.
Eye 12..these are the common symptoms that patients notice.
- blurred vision........96%
- redness ...............50%
- lid swelling ...........10%
- discharge .............10%
Notes for professionals
- Intravitreal injections, precautions:
- 30 Gauge needles and deeper injections reduce reflux and retina incarceration. (Retina 2010)
- The technique for traimsinolone
- topical anaesthetic and dilating agents
- polvidone iodine to clean eye;
- 4mm behind limbus,
- 29 gauge needle
- (triamcinolone dose: 4mg = 0.1ml triamcinolone; check suitability for intravitreal injection as here)
- expect a pressure rise in 50% at 1 month, many requiring drops/treatment, sometimes severe, as here
- some patients were retreated..most patients benefit, but usually the effect is temporary (6 months)
- one patient on anticoagulants developed a large subconjunctival haemorrhage, another developed a cataract (out of 20 patients)
- these patients had had macular oedema for years
- in our experience triamcinolone does not work if the oedema has been present for more than a year.
- it is critical to shake the triamcinolone vial and inject immediately or as soon as possible...a 10 minute delay introduces a great variation in the dose given.
- vitritis 91%
- hypopyon 75%
- hyperaeima 75%
- corneal oedema 24%
- raised IOP 10%
- outcomes Retina 19
Infections may occur 1/100-1/10000. This paper is worth reading in detail, with extracts as below.
- apply 5% polvidone-iodine (p-i) & irrigate fornix with p-i,
- apply sterile drape and speculum keeping all eyelashes covered
- apply drops of p-i over injection site
- intravitreous injection of Lucentis etc..wait a few seconds...immediately apply cotton tip to injection site to prevent reflux of injected drug
- facemask or no talking
- organisms BJO 14
- vitrectomy within 14 days may help Retina 17
- an alternative is Chlorhexidine, but in this area several infections have developed following Chlorhexidine use
- we are therefore recommending the continued use of iodine, but irrigation the out after 2 minutes after iodine installation