OSLI Retina

January 2020

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6 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina Practical Retina TOPICAL ANTIBIOTICS No trial has demonstrated benefit with topical an- tibiotics and, thus, they are not presently recommend- ed. 6 The incidence of IE has been shown to increase with topical antibiotic prophylaxis. 7 It is hypothesized that antibiotic use increases resistance of the ocular flora or that the repeated use of antibiotics, such as flu- oroquinolones, have a detrimental effect on the ability of the ocular surface to prevent infection. 8,9 SURGICAL MASK Injection-related IE is most commonly from Staphylococcus and Streptococcus species. Strepto- coccus is not normally found on the ocular surface, yet it is found in the normal flora of the upper respi- ratory tract and oral cavities. That is why it has been hypothesized that oropharyngeal droplets could be the origin of these cases of endophthalmitis. 10 This is supported by the fact that post injection IE with streptococcal isolates after IVI are approximately three-times more prevalent than when compared to intraocular surgery performed in an operating room. 11 In light of this, a face mask should be considered 12 or a no-talk policy 13,14 be instituted during the setup and injection to help prevent aerosolization of oropharyn- geal pathogens from contaminating the IVI. GLOVES Hand hygiene is essential before every patient con- tact, but there is a significant variation with the use of gloves for IVI. In the United States, 27% percent of physicians use no gloves at all during IVI. 15 There are no studies that show decreased rates of IE with the use of sterile or nonsterile gloves. In our experience, the use of gloves seems sensible but not necessarily mandated by the evidence in the literature. TOPICAL ANTISEPSIS PI is considered standard of care due to its effec- tiveness, low cost, and low incidence of microorgan- Figure 1. Methods for eyelid retraction during intravitreal injections include use of unimanual (A) or bimanual eyelid retraction (B), lid splinting (C), speculum (D), or cotton-tipped applicator eyelid retraction (E) techniques.

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