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Published on: December 7, 2016
Aqueous Chlorhexidine for Intravitreal Injection Antisepsis: A Case Series and Review of the Literature
Rohan Merani1, Zachary E McPherson2, Alan P Luckie3
1Save Sight Institute, University of Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, NSW, Australia; Concord Repatriation General Hospital, Concord NSW, Australia; Retina Associates, Chatswood, NSW, Australia.
Purpose:
To determine the incidence of endophthalmitis in a large clinical series using aqueous chlorhexidine for antisepsis before intravitreal injection and to review the ophthalmic literature regarding chlorhexidine efficacy and safety.
Design:
Multicenter retrospective case series.
Participants:
All patients receiving intravitreal injections from 7 retinal specialists.
Methods:
An audit of intravitreal injections performed by retinal specialists who exclusively used aqueous chlorhexidine 0.05% or 0.1% for prophylaxis of infective endophthalmitis was undertaken. The incidence of endophthalmitis was determined from August 1, 2011, to February 28, 2015. A literature review was performed to critically appraise the ocular safety and efficacy of aqueous chlorhexidine.
Main Outcome Measures:
Incidence of endophthalmitis after intravitreal injections.
Results:
A total of 40 535 intravitreal injections were performed by 7 retinal specialists across 3 centers. Chlorhexidine was well tolerated, and only 1 patient with a suspected allergic reaction was noted. Three cases of endophthalmitis were identified with 1 culture-positive case. The 0.0074% (1 in 13 512) per-injection rate of endophthalmitis in this series compares favorably with previous series in which povidone-iodine has been used.
Conclusions:
Aqueous chlorhexidine was associated with a low rate of postinjection endophthalmitis and was well tolerated by patients.
