toms of endophthalmitis with their patients, especially those who
are at greater risk for developing this complication. Remember that
patients with endophthalmitis classically present with pain, redness,
floaters, blurry vision or a combination of those symptoms.
Endophthalmitis often manifests within a week of cataract surgery,
although it can also occur sooner or much later in the post-operative
period.
Post-injection prevention
Ask 10 retina specialists about their protocol for administering injec-
tions and you will get 10 different responses. One thing we all agree
upon, however, is that applying 5% povidone-iodine on the ocular sur-
face before administering an intravitreal injection is the most effective
way to prevent post-injection endophthalmitis.
I like to wear non-sterile gloves, use a speculum to keep the eyelash-
es and eyelids clear of the injection space, and apply 10% povidone-
iodine on the eyelashes, lids, and periorbital skin. However, there is
mixed evidence that any of these practices decrease infection risk.
Pre-filled syringes are becoming more prevalent, and while their
effect on minimizing post-injection endophthalmitis has yet to be
proven, they do eliminate additional steps where cross-contamination
can occur. However, most of us still play an active role in preparing
the syringe, and I exercise caution when drawing up medications and
transferring needles.
Like many retina specialists, I do not wear a mask while administer-
ing injections, but I do adhere to a strict no-talking policy — for
myself and my patients — because oral flora is a common isolate in
culture-positive, post-injection endophthalmitis. I also always place a
drop of 5% povidone-iodine on the conjunctival surface over the pene-
tration site before I give the injection. There is no evidence that post-
1 2 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • N O V E M B E R 2 0 1 9
