Endophthalmitis After Intravitreal Injections in Patients With Self-reported Iodine Allergy
| Autor: | Tavé van Zyl, Dean Eliott, Robert Leonard, Bobeck S. Modjtahedi, Hemang K. Pandya |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Pars plana
Allergy medicine.medical_specialty business.industry medicine.medical_treatment Ceftazidime Vitrectomy Retrospective cohort study Eye infection medicine.disease Surgery 03 medical and health sciences Ophthalmology 0302 clinical medicine medicine.anatomical_structure Endophthalmitis 030221 ophthalmology & optometry medicine Vancomycin 030212 general & internal medicine business medicine.drug |
| Zdroj: | American Journal of Ophthalmology. 170:68-74 |
| ISSN: | 0002-9394 |
| Popis: | Purpose To present cases of endophthalmitis following intravitreal injections where povidone-iodine (PI) was not used as part of the surgical preparation. Design Retrospective case series. Methods All cases of presumed injection-related endophthalmitis presenting to the Massachusetts Eye and Ear Infirmary between June 2008 and November 2014 and Dean McGee Eye Institute between January 2010 and January 2015 were identified. Patients who did not receive PI preparation owing to documented self-reported allergy to iodine, iodine-containing contrast material, or shellfish were identified and their injection histories and clinical courses reviewed. Results The combined rate of postinjection endophthalmitis at these 2 centers was 0.019%. Among 42 patients with postinjection endophthalmitis, 5 (11.9%) did not receive PI prophylaxis. The mean number of intravitreal injections without PI before the development of endophthalmitis was 10.6 with a 9.4% rate of endophthalmitis (5 cases per 53 injections). All patients underwent tap-and-inject procedures with vancomycin 1 mg and ceftazidime 2 mg. Two patients did not receive PI at the time of tap and inject; 1 of these patients required subsequent pars plana vitrectomy for worsening clinical course. Cultures were positive in 4 of 5 cases; all positive cultures grew coagulase-negative Staphylococcus . All patients who received subsequent intravitreal injections received PI prophylaxis without allergic reactions, thus demonstrating a lack of true PI allergy. Conclusions Avoiding PI owing to self-reported iodine "allergy" risks substantial ocular morbidity. Allergy testing can be pursued per patient request or in rare cases of suspected true PI allergy; however, in cases where delayed treatment would adversely affect visual outcome, the clinician should feel confident that minimal allergic risk exists. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect