Controversies in Topical Antibiotics Use with Intravitreal Injections

Endophthalmitis following intravitreal injection is uncommon. There are currently no randomized clinical trials evaluating the role of prophylactic topical antibiotics in this setting. Many large series have reported that topical antibiotics do not decrease, and may in fact increase the rate of endophthalmitis. The reason for this apparent paradoxical finding is unknown but may be due to changes in conjunctival flora due to repeated exposure to antibiotics. At this time, antiseptics (specifically povidone-iodine), rather than antibiotics, are preferred for the majority of patients undergoing intravitreal injections.