Comparison of endophthalmitis rates following alcohol-based chlorhexidine and povidone-iodine antisepsis for intravitreal injections

In a retrospective cohort study titled “Comparison of endophthalmitis rates following alcohol-based chlorhexidine and povidone-iodine antisepsis for intravitreal injections,” authored by Amit V. Mishra et al., published in Ophthalmol Retina in 2023, the researchers aimed to compare the rates of endophthalmitis after intravitreal injections (IVI) using 0.05% chlorhexidine with 4% alcohol base antisepsis versus 10% povidone-iodine antisepsis.

The study involved eyes receiving IVI between May 2019 and October 2022 at a group retina practice in Edmonton, Canada. The main outcome measure was the rates of endophthalmitis between the two antisepsis methods. The study found that out of 170,952 IVIs performed, there were 49 cases of endophthalmitis, with 29 cases in the povidone-iodine group (0.021%) and 20 cases in the chlorhexidine group (0.064%).

The rates of endophthalmitis showed a statistically significant difference between the two groups, with higher odds of developing endophthalmitis using chlorhexidine compared to povidone-iodine antisepsis (3.1x odds).

Additionally, the odds of developing endophthalmitis were higher with aflibercept injection compared to bevacizumab. The study concludes that there is a significant difference in endophthalmitis rates between alcohol-based chlorhexidine and povidone-iodine antisepsis for IVI, suggesting that chlorhexidine is now considered a second-line antiseptic agent in their center. Further research is recommended to assess endophthalmitis rates using these two antiseptic agents.

Source: Amit V Mishra et al. “Comparison of endophthalmitis rates following alcohol-based chlorhexidine and povidone-iodine antisepsis for intravitreal injections.” Ophthalmol Retina, 2023. DOI: 10.1016/j.oret.2023.08.007.

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Retina Ward of Farabi Eye Hospital