Intravitreal drug application (IVI) has become the most frequent invasive intraocular procedure. Endophthalmitis – although rare with an incidence of 0,04% per injection – is the most devastated complication. Looking back to the initial era of IVI, infectious rates were as high as after cataract surgery. In face of a significant increased individual cumulative risk, antiseptic measures have been introduced and resulted in a marked decrease of post-IVI infections. However, except for the use of povidone iodine, there is an ongoing debate about the effectiveness of other perioperative measures. They range from the use of topical antibiotics to wearing masks/gloves and performing treatment in an office/operating theatre. Regards to treatment in the case of a manifest infection, most apply the EVS recommendations for post-cataract endophthalmitis, others prefer primary vitrectomy with antibiotics. As studies are lacking and endophthalmitis after anterior segment surgery and after primary intravitreal intervention may not be the same, the optimal treatment strategy is under debate. The current review addresses the most relevant controversial issues about prophylaxis and therapy of IVI-associated endophthalmitis and points on different points of view in Europe and the USA.

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Silvia Bopp