[Tolerance of povidone-iodine in patients treated with intravitreal injection, about 619 patients]

To analyze the perioperative impact of antiseptic protocols in patients receiving intravitreal injections.

A tolerance questionnaire using visual analog pain scales was administered to patients who received consecutive intravitreal injections between December 1st and 31st, 2024, across two tertiary centers. Data collected included: pathology treated, number of previous injections, current topical and systemic medications, pain experienced during the procedure, post-injection discomfort, duration and nature of symptoms, and the desire to consider an alternative antiseptic method.

A total of 619 patients with fully completed questionnaires were included in the analysis. The mean age was 74.4 years (±11.62), with a male-to-female sex ratio of 0.48. The mean reported procedural pain was 4.2/10 (±2.7). Fifty-three percent of patients reported experiencing discomfort for at least 24h post-injection. A desire to change the antiseptic protocol was expressed in 81% of cases.

Our findings across two centers are consistent with those of the IVIS study: one-third of patients reported pain greater than 6/10 following intravitreal injection. Half of the patients experienced discomfort lasting more than 24hours. This poor tolerance of a frequently repeated procedure can lead to treatment discontinuation. The fact that 81% of patients expressed a desire to switch antiseptic protocols highlights the need for alternatives, such as chlorhexidine, which is already used in other countries.

The choice of antiseptic agent may become a limiting factor in intravitreal injection protocols due to poor tolerance in approximately one-third of patients. In such cases, proposing an equally effective alternative is justified. Chlorhexidine represents a viable option, though it is not currently utilized in France.