Influence of Topical Ofloxacin Following Intravitreal Anti-VEGF Injections on Endophthalmitis Rates



The West of England Eye Unit was the first unit in the United Kingdom to introduce nurse practitioners performing intravitreal anti-VEGF injections. The initial protocol was for patients to have Ofloxacin drops prescribed 4 times a day for 5 days following the injection. The evidence base for this practice is limited and there were concerns regarding overuse of antibiotics with production of resistant strains as well as the burden on the patient and the cost to the National Health Service. A change in protocol was introduced with discontinuation of Ofloxacin use and replacement by a single drop of Chloramphenicol immediately after the injection.


To see if Ofloxacin drops 4 times a day for 5 days following intra-vitreal injections are needed to reduce the risk of endophthalmitis.


This was a retrospective analysis of patients having anti-VEGF injections at the West of England Eye Unit, Royal Devon and Exeter NHS Foundation Trust. Endophthalmitis rates following intravitreal injections of anti-VEGF were analysed before and after a change in drop protocol. Patients initially received Ofloxacin drops 4 times a day for 5 days following intravitreal injections. The protocol was then simplified in January 2015 to a single drop of minims Chloramphenicol given immediately after the injection with no further drops given. In both groups cleaning of the lids and conjunctival sac with Povidine Iodine 5% was performed together with placement of a drape and lid speculum. Data on patients having injections between 1st September 2012 and 31st March 2017 were analysed and the endophthalmitis rates were compared between the two groups.


The Ofloxacin treated group had 2 cases of endophthalmitis with 9,692 injections (endophthalmitis rate = 0.02%) and the Chloramphenicol treated group had 1 case of endophthalmitis with 9,683 injections (endophthalmitis rate = 0.01%).


The results show that use of Ofloxacin drops for 5 days following injections are not required to prevent endophthalmitis and can be safely omitted. This has a cost saving for hospital finances, less burden on the patient and may possibly reduce the risk of resistant bacterial strains developing due to overuse of antibiotic.


Katarzyna Chwiejczak
Exeter, United Kingdom
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