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| |  Needle Contamination Found in 6.7% of Injections for Treatment of Age-Related Macular Degeneration: Presented at ARVO By Ed Susman FT. LAUDERDALE, Fla -- May 8, 2009 -- About 1 in 16 times a patient is injected with drugs to retard age-related macular degeneration (AMD), the needle used for the intravitreal delivery is contaminated with bacteria, researchers stated here at the Association for Research in Vision and Ophthalmology (ARVO) 2009 Annual Meeting. "Contamination of intravitreal needles is much more common than the prevalence of endophthalmitis," said Henry D. Perry, MD, Cornea Service, North Shore University Hospital, and Nassau County Medical Center, and Ophthalmic Consultants of Long Island, Rockville Centre, New York, at a poster presentation on May 6. "Endophthalmitis after intravitreal injection is a rare but serious complication that may result in blindness despite aggressive treatment," Dr. Perry said. The prevalence rate is about 0.2% per injection. The source of these contaminants is not known. "One possible mechanism of endophthalmitis after intravitreal injection is the direct inoculation of the ocular surface bacteria into the vitreous cavity by the penetrating needles," he suggested, and hence, the impetus for his study. Dr. Perry and colleagues enrolled 178 patients undergoing treatment for AMD with either bevacizumab or ranibizumab and then collected the needles used to perform the intravitreal delivery of the drugs into the eye and had them cultured for bacterial organisms. About 57% of the patients were women with a median age of 82 years (range, 35 to 97 years). The patients were entered into the study between October 2008 and March 2009. He said 12 of the needles came back positive -- a contamination rate of 6.7%. Six of the needles were contaminated with Staphylococcus epidermidis; 2 were Escherichia coli; 2 were Enterococcus faecalis; 1 was Pseudomonas aeruginosa; and 1 was Klebsiella pneumoniae. Dr. Perry suggested that the contaminants were likely found on the ocular surface, indicating an incomplete antibacterial prophylaxis of the area prior to injecting the drugs. All patients were given moxifloxacin 0.5% prior to the treatment. Povidone iodine 5% was applied to the brow, eyelids, eyelashes and adjacent forehead, nose and cheek. The contamination occurred 6 times among the 52 patients receiving bevacizumab and 6 times among the 126 patients receiving ranibizumab. The difference trended toward significance (P = .052). Adults who were scheduled to receive treatment for AMD were eligible for treatment. Those with active infections were excluded. "Preoperative use of faster-killing antibiotics such as gatifloxacin 0.3% may provide a more effective ocular surface sterilisation than moxifloxacin," Dr. Perry said. Funding for this study was supported by Allergan.
[Presentation title: Prospective Investigation of Intravitreal Injection Needles Cultured Immediately Following Injection of Corticosteroids, Avastin or Lucentis. Abstract 5021/A622]
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