American Academy of Ophthalmology

View all recommendations from this society

Released February 21, 2013

Don’t routinely provide antibiotics before or after intravitreal injections.

The routine use of antibiotics before or after intravitreal injections is unnecessary because research has shown that topical antibiotics don’t prevent the occurrence of eye infection. The risks of antibiotic eye drops include allergic reactions. The overuse and repeated exposure to antibiotics can lead to the emergence of bacteria that don’t respond readily to available treatments. Routine antisepsis is appropriate and important for prevention of eye infection.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about items on this list or their individual situation should consult their ophthalmologist.

How The List Was Created

The American Academy of Ophthalmology’s Medical Director of Health Policy and Health Policy Committee led the Academy’s list development process. Members of the Health Policy Committee initially identified potential recommendations based on relevance, appropriateness and potential for improvement and efficiency. Through society notifications and newsletter notices, other ophthalmic organizations and subspecialty societies and members were invited to offer feedback and recommend ideas to be included in the final recommendations. Health Policy Committee members and the Medical Director of Health Policy reviewed the ideas and supporting evidence, and ranked them in order of potential impact. The top five recommendations were presented to the Academy’s Board of Trustees for approval.

The American Academy of Ophthalmology’s disclosure and conflict of interest policy can be found at www.aao.org

Sources

American Academy of Ophthalmology, Practicing Ophthalmologists Learning System. Intravitreal injections [Internet]. San Francisco: American Academy of Ophthalmology, 2008 Nov. [cited 2012 Sep 28]; Available from: one.aao.org/CE/PracticeGuidelines/ClinicalStatements_Content.aspx?cid=404813e9-b3dc-4d6d-a2c5-d1f1e78a926b#section4.

Bhavsar AR, Googe JM, Stockdale CR Bressler NM, Brucker AJ, Elman MJ, Glassman AR. Diabetic Retinopathy Clinical Research Network. Risk of endophthalmitis after intravitreal drug injection when topical antibiotics are not required. The Diabetic Retinopathy Clinical Research Network Laser-Ranibizumab-Triamcinolone Clinical trials. Arch Ophthalmol [Internet]. 2009 Dec;127(12):1581-3.

Scott IU, Flynn HW. The role of topical antibiotic prophylaxis for intravitreal injections. Arch Ophthalmol [Internet]. 2007 Jul;125(7):974-6.

Bhatt SS, Stepien KE, Joshi K. Prophylactic antibiotic use after intravitreal injection: Effect on endophthalmitis rate [Internet]. Retina. 2011 Nov;31(10):2032-6.

Kim SJ, Toma HS, Midha, Cherney EF, Recchia FM, Doherty TJ. Antibiotic resistance of conjunctiva and nasopharynx evaluation study: A prospective study of patients undergoing intravitreal injections. Ophthalmol [Internet]. 2010 Dec(12):117-2372-8.

Kim SJ, Toma KS. Ophthalmic antibiotics and antimicrobial resistance. A randomized, controlled study of patients undergoing intravitreal injections. Ophthalmol [Internet]. 2011 Jul(7);118:1358–1363.

Cheung CSY; Wong AWT, Kertes PJ, Devenyi RG, Lam WC. Incidence of endophthalmitis and use of antibiotic prophylaxis after intravitreal injections. Ophthalmol [Internet]. 2012 Aug:119(8):1609-14.

Milder E, Vander J, Shah C, Garg S. Changes in antibiotic resistance patterns of conjunctival flora due to repeated use of topical antibiotics after intravitreal injections. Ophthalmol [Internet]. 2012 Jul:119(7):1420-4.