5PSQ-054 Endophthalmitis after intravitreal injection with anti-angiogenic drugs: a rare but serious complication

Objective: Investigate the distribution of bacteria in the conjunctival sac of two groups of cataract patients with different preoperative aseptic treatments, and compare the clinical effects of 0.5% povidone-iodine (PI) and antibiotic eye drops on killing conjunctival sac bacteria.Methods: 400 cases of patients (400 eyes) who underwent cataract surgery in the Department of Ophthalmology of Baogang Hospital in Inner Mongolia from October 2019 to October 2020 were selected in a randomized controlled study. They were randomly divided into the experimental group (group A) and the control group (group B), with 200 cases in each group. Group A: the patients were given Gatifloxacin Eye Gel (3 times/day, 1 drop/time) combined with Diclofenac Sodium Eye Drops (4 times/day, 1 drop/time) before the operation; 0.5% PI was administered to irrigate the conjunctival sac, with 0.9% SodiumChloride Injection washing after 3 min; 0.5% PI was administered to irrigate the conjunctival sac after operation. The corneal epithelium was observed after each irrigation. Group B: the patients were given Gatifloxacin Eye Gel (3 times/day, 1 drop/time) combined with Diclofenac Sodium Eye Drops (4 times/day, 1 drop/time) 2 days and 1 day before the operation; 0.9% Sodium Chloride Injection was administered to irrigate the conjunctival sac before and after surgical disinfection. Conjunctival sac specimens were collected for bacterial culture 2 hours before the operation, after irrigation, and after the procedure. The positive rate and the distribution of bacteria were compared between the two groups.Results: The difference in the positive rate of bacteria in the conjunctival sac between the two groups at different time points had a statistical significance (χ2 = 11.498, p < .022). Conjunctival sac specimens were collected on admission and 2 hours before the operation. There was no significant difference in the pathogens with positive results between the two groups (p = .955; p = .073); there was a substantial difference in the distribution of positive pathogens between the two groups before and after surgical disinfection (p < .001); there was a significant difference in the distribution of pathogens between the two groups after the operation (p = .005). For Staphylococcus epidermidis, Corynebacterium, Enterococcus faecalis, Streptococcus, and other Gram-positive bacteria, there was a significant difference in the disinfection methods between the two groups at different time points (p < .001); for Staphylococcus aureus, Gram-positive cocci, and Gram-negative bacteria, there was no significant difference in the disinfection methods between the two groups at different time points (p = .113; p = .224; p = .146). There was no significant difference between the two groups with 0-10 and 101-1000 bacterial colonies at different time points (p = .370 and .071, respectively). When there were 11-100 bacterial colonies, there was a significant difference between the two groups at different time points (p < .001). There was no significant difference in corneal epithelial injury between the two groups at other time points (χ2 = 4.133, p = .127).Conclusions: The combination of 0.5% PI disinfectant and antibiotic eye drops can effectively reduce the bacterial load of the conjunctival sac before operation. At the same time, it is safe and effective to irrigate the conjunctival sac with 0.5% PI disinfectant before the procedure.

To assess the efficacy, duration of effect and safety of one intravitreal injection of bevacizumab in diabetic macular oedema (DMO). Bevacizumab (1 mg/0.04 ml) was injected intravitreally into eyes with DMO (29 with and nine without previous treatments). Best corrected visual acuity (BCVA), intraocular pressure and central retinal thickness (CRT) were measured; slit-lamp examination, macular biomicroscopy, optical coherence tomography and fluorescein angiography were performed before and at 2-4, 8 and 12 weeks post-injection. Best corrected VA and CRT were analysed in both groups. In the non-pretreated group, mean BCVA improved from 0.76 +/- 0.33 (baseline) to 0.57 +/- 0.30 and 0.54 +/- 0.27 at 2-4 weeks and 8 weeks post-injection, respectively (p = 0.02, p = 0.014, paired t-test). Mean CRT decreased from 632.4 +/- 196.0 microm (baseline) to 392.3 +/- 113.6 microm and 370.4 +/- 141.7 microm at the same time-points, respectively (p = 0.01, p = 0.01). There was no difference in BCVA or CRT at 12 weeks. In the pretreated group, mean BCVA improved from 0.62 +/- 0.30 (baseline) to 0.53 +/- 0.33 at 2-4 weeks post-injection (p = 0.01), and mean CRT decreased from 583.9 +/- 180.7 microm (baseline) to 404.1 +/- 197.9 microm at 2-4 weeks post-injection (p < 0.001). Mean BCVA was unchanged at 8 weeks and 12 weeks post-injection, although mean CRT remained lower at 8 weeks (p = 0.004). No ocular or systemic side-effects developed during follow-up. One intravitreal injection of bevacizumab for DMO seems to be effective and safe in both eyes that have been treated previously and eyes that have not. The therapeutic effect is temporary and repeat treatment may be needed.

Background/Aim: The most important complication after intravitreal injection (IVI) is endophthalmitis, which can result in severe vision loss. This study aims to investigate the effect of 0.25% povidone-iodine (PI) application before IVI on the incidence of endophthalmitis in patients who received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection.Methods: A total of 15345 intravitreal anti-VEGF injections and nine endophthalmitis cases after IVI performed at the outpatient injection room of a single university hospital between January 2017 and January 2020 were included in this retrospective cohort study. Before July 2018, after applying 10% PI around the eyes and 5% PI on the eyes, an eyelid speculum was inserted, and the injection was performed. After this date, in addition to these steps, after placing a speculum and determining the injection site with a caliper, 3-4 drops of 0.25% PI were applied just before injection. Topical antibiotics were not used before or after the injection.Results: Nine cases of endophthalmitis were detected in 3 years. The most common symptoms were vision loss (9/9) and pain in the eye (7/9). All cases had conjunctival hyperemia, cells-hypopyon in the anterior chamber, and cells in the vitreous. The time between injection and re-visiting the clinic due to endophthalmitis symptoms ranged between 2-6 days, and visual acuity varied between hand motion and 0.2. While the number of endophthalmitis cases before July 2018 was 8 (8/8330) in 1.5 years, after the addition of 0.25% PI application to the protocol, only 1 case of endophthalmitis (1/7015) was seen in the last 1.5 years. The rate of endophthalmitis had decreased significantly (P=0.037).Conclusion: Since July 2018, the addition of 0.25% PI to the standard IVI protocol just before injection has significantly reduced endophthalmitis rates. With this method, endophthalmitis rates may be decreased despite the increasing number of IVIs.

Inhibitory Effect of Short-Term Palpebral Margin Cleaning with Antibiotic Eye Drops on Ocular Surface Flora before Cataract Extraction: A New Preoperative Antibacterial Method

Background:The objective of the study was the determination of the incidence of culture-proven postoperative endophthalmitis and probable sources of infection.Materials and Methods:It was a prospective study on the microbiology, incidence and probable sources of infection in patients with postoperative infectious endophthalmitis carried out in a tertiary care eye hospital. Consecutive patients diagnosed with postoperative infectious endophthalmitis during the years 2000-2007 were investigated for the causative infective agent and possible sources of infection. The surgical data and microbiological data including the investigations performed to trace the source were recorded in a specific formatted form and were gathered and compiled for analysis.Results:Data of analysis showed that 98 (0.042%) out of 2,31,259 patients who underwent intra-ocular surgery developed infectious endophthalmitis. Among these, 70 (0.053%) occurred after cataract, 10 (0.5%) after penetrating keratoplasty (PK) and 18 (0.018%) following other types of intra-ocular surgeries. The predominant infectious agents isolated were bacteria (89.7%), with equal proportions of Gram-positive and Gram-negative bacteria. Polymicrobial infection was noted in four and fungi in seven patients. Occurrence of postoperative endophthalmitis was sporadic and not related to any specific part of period in a year. Sources of infection were donor corneal rim in six post-PK patients and phaco probe in one who had postphacoemulsification endophthalmitisConclusions:Overall incidence of postoperative endophthalmitis over an 8-year period was quite low. The sources of infection could be established in six post-PK endophthalmitis patients and in a postcataract surgery.

Objective: To explore the clinical significance of ocular surface bacteria inhibition by cleaning eyelid margins before surgery in cataract patients. Methods: Case-control study. Thirty-five patients (45 eyes) with age-related cataracts who were proposed to receive treatment of Phacoemulsification combined with cataract extraction and intraocular lens implantation at Peking University 3(rd) hospital were included. The experimental group consisted of 9 males and 15 females with the average age of (69.8±11.5). The control group consisted of 6 males and 15 females with the average age of (61.8±16.2). In the experimental group, bacteria samples from the conjunctival sac and eyelid margins were collected at three times separately and were cultured for identification: first sampling was taken prior to application of any type of antimicrobial measures; second sampling was taken after application of lid scrub twice daily for 7 days to cleanse their eyelid margins by the patients;the last sampling was taken after patients' application of Levofloxacin antibiotic eye drops 3 times per day continuously for 3 days prior to surgery. In the control group, bacteria samples from the conjunctival sac and eyelid margins were collected at two times separately and were cultured for identification: first sampling was taken before application of any antimicrobial measures;second sampling was taken after patients' application of only Levofloxacin antibiotic eye drops successively for 3 days before surgery. Then the results of bacteria culture of the two groups above were compared. Results: In the experimental group, according to the eyelid margins bacteria cultures results of the first sampling (taken before application of any antibacterial measures), the total positive rate, positive rate of common bacteria and positive rate of rare bacteria found in the cultures were 83.3% (20/24), 70.8% (17/24), 45.8% (11/24), respectively; according to the bacteria cultures results of the second sampling (tanken after application of lid scrub for cleaning the eyelid margins for 7 days), the total positive rate, positive rate of common bacteria and positive rate of rare bacteria found in the cultures were 58.3% (14/24), 45.8% (11/24), 25% (6/24), respectively;According to the bacteria cultures results of the third sampling (taken after application of antibiotic eye drops for three days), the total positive rate, positive rate of common bacteria and positive rate of rare bacteria found in the cultures were 20.8% (5/24), 20.8% (5/24), 4.2% (1/24), respectively. In the experimental group, we compared the bacterial positive rate of the samples taken after patients' application of antibiotics for 3 days to the bacterial positive rate of the samples taken prior to application of any antibacterial measures to have found that the total positive rate, the positive rates of common bacteria and rare bacteria decreased significantly (P<0.05) and the difference in between are of statistical significance. In the control group, according to the eyelid margins bacteria cultures results of the first sampling (taken before application of any antibacterial measures, the total positive rate, positive rate of common bacteria and positive rate of rare bacteria found in the cultures were 81% (17/21), 66.7% (14/21), 19% (4/21), respectively;According to the bacteria cultures results of the second sampling (taken after the application of antibiotic eye drops for three days), the total positive rate, positive rate of common bacteria and positive rate of rare bacteria found in the cultures were 38.1% (8/21), 14.3% (3/21), 33.3% (7/21) respectively. When comparing the experimental group to the control group, the experimental group yielded significantly better results than the control group for the rate of reduction of rare bacteria in the eyelid margin after using antibiotics for 3 days. This is due to the lid scrub being used with the antibiotics. The difference are of statistical significance (χ(2)=6.518, P=0.017). There was no statistically significant difference between the experimental and control group in terms of the total positive rate as well as the positive rate of common bacteria and rare bacteria in the conjunctival sac. Conclusions: The cleaning of the eyelid and eyelid margin with lid scrub prior to cataract surgery combined with antibiotics eye drops will achieve excellent antibacterial effects for common and rare bacteria in the eyelid and conjunctival sac. The antibacterial effect of using lid scrub with antibiotic eye drops is more favorable than that of using antibiotic eye drops only. However, the lid scrub eyelid hygiene products cannot replace preoperative antibiotics independently. (Chin J Ophthalmology, 2018, 54: 445-451).

To assess the effect of intravitreal bevacizumab on diabetic macular oedema (DMO) and retinal vessel calibres. We performed a consecutive case series study in which 10 consecutive eyes with diffuse DMO, two of which had not previously been treated, received an intravitreal injection of bevacizumab 1 mg, which was followed by two more injections at 6-week intervals. Fundus photography and optical coherence tomography (OCT) were carried out at baseline immediately before injection and at 1, 2.5 and 4 months after the first injection. Outcome measures were best corrected visual acuity (BCVA) in Early Treatment Diabetic Retinopathy Study letters, macular volume, foveal subfield thickness and vessel diameter measurement. Intravitreal administration of bevacizumab was followed by a mean increase in BCVA of 7.3 +/- 17 (mean +/- standard deviation) letters between baseline and month 4, which was 1 month after the last injection (p < 0.0001). This was accompanied by a reduction in mean macular volume from 9.90 +/- 1.9 mm(3) to 8.96 +/- 2.4 mm(3) (p = 0.002) and in foveal subfield thickness from 447 +/- 117 microm to 388 +/- 117 microm (p = 0.03). Two eyes with early proliferative diabetic retinopathy lost all signs of proliferation without any evidence of fibrosis. Although there was a trend towards vasoconstriction, the changes in vessel diameters (arteries and veins) after 4 months of intravitreal Avastin injection were not statistically significant (p = 0.9 and p = 0.17, respectively). Foveal thickness in non-injected fellow eyes with DMO changed from 428 +/- 153 microm at baseline to 383 +/- 151 microm at 4 months (p = 0.1), which did not reach statistical significance. Intravitreal bevacizumab 1 mg every 6 weeks was followed by a moderate reduction in DMO without normalization of foveal and macular thickness. Our observations suggest that a larger study where patients are examined sooner after injection is needed to elucidate the potential relationship between changes in retinal vessel diameters and thickness changes in DMO.

Objective To observe the influence of 0.025％ povidone iodine (PI) on ocular surface after dropped in conjunctival sac for preoperative sterilization before cataract surgery.Methods Sixty cata ract patients (60 eyes) were treated by conjunctival sac sterilization for 30 seconds with 0.025％ povidone iodine 0.1 ml before cataract surgery.Lacrimal river height,corneal fluorescein staining,tear film break-up time (BUT),Schirmer's I test and conjunctiva impression cytology detection were observed on 3 d before surgery and 1 d,7 d,30 d postoperatively.A11 operations were phacoemulsification and intraocular lens implantation and performed by the same doctor.Then tobradex eye drops,sodium hyaluronate eye drops,pranoprofen eye drops were administered postoperatively.Results There was no statistical difference in lacrimal river height,Schirmer's I test,conjunctiva impression cytology detection between preoperative and postoperative.There was statistical difference about BUT among the 1 d,7 d postoperatively and preoperatively.There was statistical difference in corneal fluorescein staining scores between the 1 at day postoperatively and preoperatively.No statistical difference was detected after one week.There was no statistical difference on the 30th day.There was statistical difference in BUT between the 1 d,7 d postoperatively and preoperatively.There was no statistical difference after one month.There was statistical difference in corneal fluorescein staining scores between preoperative and postoperative 1st day,1st week and 1st month.Conclusion 0.025％ PIis safe for preoperative comjunctival sac sterilization for cataract patient.But the mean BUT reduced and corneal fluorescein staining increased on the postoperative early stage,the ocular surface recover in one month.The symptoms are more common in the patients with dry eye preoperatively,all of which recovered in one month. Key words: Povidone iodine; Conjunctival sac; Cataract; Ocular surface; Sterilize

To study antibiotic resistance patterns and susceptibility to eye antiseptic picloxydine of conjunctival flora in patients undergoing intravitreal injections (IVIs). Conjunctival swabs were taken in 4 groups of patients, 20 patients in each group (n=80): without IVIs and ophthalmic operations in history (group N1; control group); with the first IVI and antibiotic eye drops Tobrex applied 3d before IVI and 5d after it (group N2); with 20 or more IVIs and repeated courses of antibiotic eye drops (group N3); with the first IVI and antiseptic eye drops Vitabact (picloxydine) applied 3d before IVI and 5d after it (group N4). In groups N2 and N4 swabs were taken at baseline and after the treatment. Efficacy of picloxydine in inhibition of growth of conjunctival isolates susceptible and resistant to antibiotic was studied in vitro. Minimal inhibition concentrations (MIC) were determined with microdilution test. Two of the three patients who had to undergo the IVI procedure showed conjunctiva bacterial contamination. Along with few Staphylococcus aureus and Gram-negative isolates susceptible to most antibiotics, the majority (71%-77%) of causative agents were coagulase-negative Staphylococci (CoNS), 40%-50% of which were multidrug resistant (MDR). Eye disinfection in the operating room and peri-injection courses of Tobrex or Vitabact resulted in total elimination of isolates found at baseline. However, in 10% and 20% of patients, respectively, recolonization of the conjunctiva with differing strains occurred. In patients with repeated IVI and Tobrex/Maxitrol treatment, the conjunctival flora showed high resistance rates: 90% of CoNS were MDR. In the in vitro study, picloxydine showed bactericidal effect against Staphylococci isolates both antibiotic resistant and susceptible with MIC≥13.56 µg/mL. Incubation of bacteria for 15min in Vitabact eye drops, commercially available form of picloxydine, 434 µg/mL, showed total loss of colony forming units of all tested isolates including Pseudomonas aeruginosa. The confirmed efficacy of eye antiseptic picloxydine against conjunctival bacterial isolates and the presence of its commercial form, 0.05% eye drops, convenient for use by patients before and after injection, make this eye antiseptic promising for prophylaxis of IVI-associated infectious complications.

Acute bacterial conjunctivitis – benefits versus risks with antibiotic treatment

Our objectives were (1) to report the post-injection endophthalmitis rate over 18 months, and (2) to determine any difference in the incidence of endophthalmitis in patients treated with reduced or no 5% povidone-iodine (PI) due to self-reported PI sensitivity. We performed a retrospective cohort study of all patients who received intravitreal injections (IVIs) from January 1st, 2018 to June 26th, 2019. Information on patients' age, gender visual acuities, the number of injections, drug administered, self-reported iodine sensitivity and injection protocols were obtained from electronic and paper records. For endophthalmitis cases, vitreous culture results and treatment were also noted. Patients were divided into three cohorts based on the injection protocol used for statistical analysis. During the study period 22,046 IVIs were administered to 3332 eyes of 2709 patients. Intolerance to PI was reported by 2.4% of patients. The incidence of endophthalmitis was 0.02% (4/21,185) with the standard 5% PI protocol, 0.78% (6/769) with a reduced PI protocol involving fewer drops of 5% PI and chlorohexidine 0.05% for periorbital skin cleansing, and 1.09% (1/92) without any PI use. Receiving the standard PI protocol was associated with significantly lower rates of endophthalmitis compared to both the reduced PI and no PI protocols (p < 0.0001). Patients who opt for less or no PI use are likely at significantly increased risk of developing post-IVI endophthalmitis. It is imperative to educate, counsel and consent these patients accordingly while exploring alternative antiseptic solutions.

PurposeTo evaluate the conjunctival sac flora before and after intravitreal injection (IVI) in eyes with no prophylactic antibiotic use.Methods37 eyes of 37 patients not using systemic or local antibiotics for at least 30 days were included. Microbiological culture from conjunctiva sac to nutrient media was taken twice: before IVI and before any topical medications were given and 30 minutes after anty‐VEGF IVI. Topical antibiotics were not used neither before, nor after IVI. Shortly before IVI conjunctival sac was rinsed with 5% povidone‐iodine (PVI). Control group constituted eyes not treated with IVI of the same patients.ResultsNegative microbiological cultures before and after IVI were noted in the studied group in 15 patients (40.5%) and in 9 control eyes (24.3%). Coagulase‐negative Staphylococci (CNS) were cultured in 13 eyes (35.1%) before IVI and in 8 eyes (21.6%) after IVI. In 3 eyes (8.1%) Staphylococcus aureus was shown before IVI, with subsequent negative cultures. In the control group CNS was shown in 14 eyes (37.8%) before IVI and in 7% (18.9%) after IVI. Microbiological flora was identical in studied and control groups in 14 cases (37.8%). There was no case of post‐IVI endophthalmitis.ConclusionsAbout 50% of cultures were negative, in 35% ‐ CNS, and in 15% ‐ other bacteria were cultured, including Staphylococcus aureus in 8%. The number of negative cultures after IVI (the use of PVI) was higher than before IVI, and all Staphylococcus aureus were eliminated. The eye antisepsis based on PVI in IVI is an effective and efficient prophylaxis method.

PurposeTo evaluate the conjunctival sac flora before and after intravitreal injection (IVI) in eyes with no prophylactic antibiotic use.Methods37 eyes of 37 patients not using systemic or local antibiotics for at least 30 days were included. Microbiological culture from conjunctiva sac to nutrient media was taken twice: before IVI and before any topical medications were given and 30 minutes after anty‐VEGF IVI. Topical antibiotics were not used neither before, nor after IVI. Shortly before IVI conjunctival sac was rinsed with 5% povidone‐iodine (PVI). Control group constituted eyes not treated with IVI of the same patients.ResultsNegative microbiological cultures before and after IVI were noted in the studied group in 15 patients (40.5%) and in 9 control eyes (24.3%). Coagulase‐negative Staphylococci (CNS) were cultured in 13 eyes (35.1%) before IVI and in 8 eyes (21.6%) after IVI. In 3 eyes (8.1%) Staphylococcus aureus was shown before IVI, with subsequent negative cultures. In the control group CNS was shown in 14 eyes (37.8%) before IVI and in 7% (18.9%) after IVI. Microbiological flora was identical in studied and control groups in 14 cases (37.8%). There was no case of post‐IVI endophthalmitis.ConclusionsAbout 50% of cultures were negative, in 35% – CNS, and in 15% – other bacteria were cultured, including Staphylococcus aureus in 8%. The number of negative cultures after IVI (the use of PVI) was higher than before IVI, and all Staphylococcus aureus were eliminated. The eye antisepsis based on PVI in IVI is an effective and efficient prophylaxis method.

To evaluate the incidence, causative organism, clinical features, and visual outcome of acute endophthalmitis following intravitreal injection and to report the clinical outcome of patients receiving preinjection antibiotics for the prevention of endophthalmitis. For all intravitreal triamcinolone acetonide, bevacizumab, ranibizumab, and C3F8 gas injections performed in our outpatient clinic between June 2008 and November 2012, the number of injections, indications, types of administered drugs, and methods of injection were investigated. A retrospective chart review was performed comparing patients with self-administration of antibiotic eye drops for 3 days before injection (n=8649 injections), and patients those who received no pretreatment with antibiotics (n=8683 injections). Cases of suspected endophthalmitis after intravitreal injection during this period were identified and reviewed retrospectively. The total number of intravitreal injections was 17,332. The incidence of acute endophthalmitis for all intravitreal injections was 0.000% (0/849) for triamcinolone acetonide, 0.022% (2/9,125) for bevacizumab, 0.000% (0/7,061) for ranibizumab, and 0.337% (1/297) for C3F8 gas injections. The overall rate of intravitreal injection-related endophthalmitis with the use of topical antibiotics given 3 days before injection was no less statistically significant compared with that of no antibiotics. Staphylococcus species was confirmed in the bacterial culture of one eye with acute endophthalmitis. After early vitrectomy and intravitreal antibiotic injection, one eye maintained vision, but the other eye developed phthisis. All 3 endophthalmitis patients had not taken prophylactic preinjection topical antibiotics, but the difference in the rates of endophthalmitis between those who received a multiday course of preinjection antibiotics and those who did not was not statistically significant. The rate of endophthalmitis after intravitreal injection using aseptic techniques in the clinical practice setting is similar with or without the use of preinjection antibiotics. Preinjection antibiotic use confers no additional benefit in the treatment of endophthalmitis compared to without preinjection antibiotics.

This study compared povidone-iodine alone versus povidone-iodine with antibiotics to prevent endophthalmitis after intravitreal bevacizumab injections for macular oedema. It aimed to find the best infection prevention method. Objective: To determine the efficacy of per-operative 5% povidone-iodine alone vs combined per-operative 5% povidone-iodine with topical antibiotics for reducing the frequency of endophthalmitis in patients undergoing repeated intravitreal injection of Anti-VEGF (Bevacizumab). Methods: This randomised control trial was conducted at the Department of Ophthalmology, Sir Ganga Ram Hospital, Lahore. Patients meeting inclusion criteria were enrolled after taking informed written consents, and two equal groups were made on a random basis using a lottery method: Group A (Povidone Iodine Alone) and Group B (Povidone Iodine with Topical Antibiotics). The procedure was performed per the hospital's standard protocol, and variables were noted for data analysis. Results: The mean age was 51.23±12.43 years, with a balanced gender ratio (52.6% male, 47.4% female). Injections were predominantly in the right eye (52.9%) versus the left (47.1%). Diabetic macular oedema (57.4%) was most prevalent, followed by choroidal neovascularization (17.1%), central retinal vein occlusion (8.9%), branch retinal vein occlusion (10.9%), and other pathologies (5.7%). Groups A and B had similar baseline characteristics (p&gt;0.05). Both groups had a 0.6% endophthalmitis rate (p=1.000), each with 175 patients. Conclusion: This study comparing 5% povidone-iodine alone versus 5% povidone-iodine with topical antibiotics for prophylaxis during intravitreal bevacizumab injections did not demonstrate a significant difference in the incidence of endophthalmitis between the two groups.