Is there a rational for the use of topical antibiotics before and after intravitreal injections

Treatment of wet age-related macular degeneration (AMD) requires frequent intravitreal injections of anti-VEGF agents, sometimes on monthly basis during a long period of time. Endophthalmitis is a rare but extremely severe complication of intravitreal injections. As it has been proven before, the flora from the conjunctival surface is the main source for endophthalmitis. Using Povidone-iodine solution (Betadine10 % Povidone-iodine, EGIS PHARMACEUTICALS) is the only way to prevent endophthalmitis. The efficacy of it was proven by numerous studies. No evidence exists that topical antibiotiotics prior and after injections could be effective for prevention of endophthalmitis. Purpose: To study the advisability of topical antibiotic application before intravitreal injection. Materials and methods: Under investigation, there were 25 eyes of 25 patients with wet AMD treated by anti-VEGF intravitreal injections. All patients used topical antibiotics 3 days before injection. Conjunctival culture from injection eye was collected three times: before topical antibiotic use; after topical antibiotic use, and after Betadine 5 % application. Results: The rates of Staphylococcus epidermidis before and after topical antibiotic use were approximately equal. However there was no Staphylococcus epidermidis found after Betadine 5 % application. Conclusion: Our study showed the effectiveness of Betadine 5 % solution in conjunctival flora reduction. Use of topical antibiotics 3 days prior intravitreal injections is not effective. Key words: age-related macular degeneration; endophthalmitis; intravitreal injection; topical antibiotics; endophthalmitis prevention.

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D2-dopamine receptor blockade modulates temporal resolution in goldfish

Visual Neuroscience ◽

10.1017/s0952523802196106 ◽

2002 ◽

Vol 19 (6) ◽

pp. 807-815 ◽

Cited By ~ 11

Author(s):

CARLOS MORA-FERRER ◽

VOLKER GANGLUFF

Keyword(s):

Dopamine Receptor ◽

Temporal Resolution ◽

Sch 23390 ◽

Recovery Phase ◽

Intravitreal Injections ◽

D2 Dopamine Receptor ◽

Flicker Fusion Frequency ◽

Choice Procedure ◽

Before And After ◽

6 Hydroxydopamine

A possible effect of dopamine on the temporal resolution of goldfish was investigated in a behavioral, two-alternative, forced-choice procedure. Flicker fusion frequency (FFF) was measured before and after bilateral intravitreal injections of D1- or D2-dopamine receptor (D1-/D2-R) antagonists, or after depletion of retinal dopamine by bilateral intravitreal injections of the dopaminergic neurotoxin 6-hydroxydopamine (6-OHDA). Prior to drug injections, fish achieved FFFs of 33–39 Hz. A D1-R antagonist, SCH 23390, reduced FFF by about 12% (P > 0.1), whereas a D2 antagonist, sulpiride, reduced the relative FFF by 25% (P < 0.03). Depletion of retinal dopamine with 6-OHDA induced a gradual reduction in the FFF to a maximal reduction of 50% (P < 0.001) at 2 weeks postinjection. There was recovery to control levels after 3–4 weeks postinjection. The recovery of FFF, at least in one animal, was due to the return of retinal dopamine because FFF could be reduced by intravitreal injections of sulpiride during the recovery phase. These experiments demonstrate that retinal dopamine, particularly acting on D2-R, is important for photopic temporal resolution.

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Impurities in Drug Vials Intended for Intravitreal Medication

Case Reports in Ophthalmological Medicine ◽

10.1155/2020/8824585 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Lisa Pohl ◽

Lisa Strudel ◽

Spyridon Dimopoulos ◽

Focke Ziemssen

Keyword(s):

Critical Incident ◽

Vision Loss ◽

Outer Edge ◽

Intravitreal Injections ◽

Injection Process ◽

Tertiary Center ◽

Before And After ◽

Severe Vision Loss ◽

Materials Used ◽

Drug Solution

Sterility is an important prerequisite for minimizing the risk of severe vision loss due to endophthalmitis after intravitreal injections. We describe three cases series of incidents where an unclear contamination of the drug solution or syringe caused the injection process to stop and continue with a new preparation. During a period of 12 months with 30,502 intravitreal injections at a tertiary center, wherein 7,076 were of the drug Aflibercept drawn up from a glass vial, three cases of the critical incident reporting system relating to intravitreal injections were identified: (1) After a typical contact with the filter cannula, the glass of an Aflibercept vial was no longer intact. (2) In the course of another injection, there was a clear deposition of debris on the outer edge of the syringe when removing the attached filter cannula. (3) After inserting the syringe into the rubber top of the vial, a whitish particle of unclear origin was identified within the drug solution. Later, this contamination/particle was identified as part of the greyish rubber that was punched out with the cannula, according to the analyses of the material sent in and the manufacturer’s investigations. Thus, even in busy clinics, visual inspection of the injection solution and materials used for impurities, preferably before and after pulling them out of a vial, must be an essential part of the injection process. Even when using ready-to-use prefilled syringes (PFS), vigilance must be kept high, knowing the risk of potential contamination.

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Dexamethasone PLGA Microspheres for Sub-Tenon Administration: Influence of Sterilization and Tolerance Studies

Pharmaceutics ◽

10.3390/pharmaceutics13020228 ◽

2021 ◽

Vol 13 (2) ◽

pp. 228

Author(s):

Deyanira Barbosa-Alfaro ◽

Vanessa Andrés-Guerrero ◽

Ivan Fernandez-Bueno ◽

María Teresa García-Gutiérrez ◽

Esther Gil-Alegre ◽

...

Keyword(s):

Particle Size ◽

In Vitro Release ◽

Intravitreal Injections ◽

Plga Microspheres ◽

Promising Alternative ◽

Before And After ◽

Evaporation Technique ◽

Release Profiles

Many diseases affecting the posterior segment of the eye require repeated intravitreal injections with corticosteroids in chronic treatments. The periocular administration is a less invasive route attracting considerable attention for long-term therapies. In the present work, dexamethasone-loaded poly(lactic-co-glycolic) acid (PLGA) microspheres (Dx-MS) were prepared using the oil-in-water (O/W) emulsion solvent evaporation technique. MS were characterized in terms of mean particle size and particle size distribution, external morphology, polymer integrity, drug content, and in vitro release profiles. MS were sterilized by gamma irradiation (25 kGy), and dexamethasone release profiles from sterilized and non-sterilized microspheres were compared by means of the similarity factor (f2). The mechanism of drug release before and after irradiation exposure of Dx-MS was identified using appropriate mathematical models. Dexamethasone release was sustained in vitro for 9 weeks. The evaluation of the in vivo tolerance was carried out in rabbit eyes, which received a sub-Tenon injection of 5 mg of sterilized Dx-MS (20–53 µm size containing 165.6 ± 3.6 µg Dx/mg MS) equivalent to 828 µg of Dx. No detectable increase in intraocular pressure was reported, and clinical and histological analysis of the ocular tissues showed no adverse events up to 6 weeks after the administration. According to the data presented in this work, the sub-Tenon administration of Dx-MS could be a promising alternative to successive intravitreal injections for the treatment of chronic diseases of the back of the eye.

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Do You Still Use Topical Antibiotics after Intravitreal Injections?

The Ophthalmology - Open Journal ◽

10.17140/ooj-3-117 ◽

2019 ◽

Vol 3 (1) ◽

pp. 5-9

Author(s):

Banu Turgut Öztürk ◽

Keyword(s):

Intravitreal Injections ◽

Topical Antibiotics

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Direction-selective responses of units in the dorsal terminal nucleus of cat following intravitreal injections of bicuculline

Visual Neuroscience ◽

10.1017/s0952523800005800 ◽

1990 ◽

Vol 4 (6) ◽

pp. 605-617 ◽

Cited By ~ 10

Author(s):

K.L. Grasse ◽

M. Ariel ◽

I.D. Smith

Keyword(s):

Ganglion Cells ◽

Intravitreal Injections ◽

Retinal Ganglion ◽

Optic System ◽

Accessory Optic System ◽

Before And After ◽

Gaba Antagonist ◽

Contralateral Eye ◽

First Time ◽

Stimulation Of

AbstractExtracellular recordings from single units in the dorsal terminal nucleus (DTN) of the cat accessory optic system (AOS) were before and after intravitreal injections of the GABA antagonist bicuculline methiodide (BMI). Direction-selective responses of DTN cells elicited through the contralateral, injected eye were aboloshed 7−12 h following the injection. For the concentrations tested, direction-selective responses through the contralateral (injected) eye did not recover within 26 h. Direction-selective responses through stimulation of the ipsilateral (uninjected) eye were also dramatically depressed for 1−9 h after contralateral eye injections. However, direction-selective responses through the ipsilateral eye eventually returned and were often more vigorous in the final stages. BMI injections into the ipsilateral eye failed to block direction-selective responses through the ipsilateral eye. The effects of intravitreal BMI on contralateral eye responses imply that DTN units receive input from direction-selective retinal ganglion cells. In addition, these results suggest that direction-selective input to the DTN from the visual cortex is independent of the retinal pathway. Using pharmacological methods described here, for the first time direction-selective responses of AOS units driven through the ipsilateral eye can be experimentally isolated.

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Controversies in Topical Antibiotics Use with Intravitreal Injections

Current Pharmaceutical Design ◽

10.2174/1381612821666150909101045 ◽

2015 ◽

Vol 21 (32) ◽

pp. 4703-4706 ◽

Cited By ~ 9

Author(s):

Stephen Schwartz ◽

Harry Flynn ◽

Andrzej Grzybowski

Keyword(s):

Intravitreal Injections ◽

Topical Antibiotics ◽

Antibiotics Use

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