Reply to Dr Grzybowski

Abstract

Sir, We thank Dr Grzybowski for his interest in our manuscript. His comments1 are consistent with those that we mentioned in the paper: ‘a significant increase in the antibiotic resistance of the isolated specimens from ocular flora' and ‘a greater rate of endophthalmitis with the use of topical antibiotics'.2 As we stated in our manuscript, we reviewed the articles that have been published in the literature from January 2005 to November 2012.2 After our manuscript was in press, several reports, including those discussed by Dr Grzybowski, were published describing the use of antibiotics in intravitreal injections. Although high-quality prospective randomized clinical trials comparing the rate of post-injection endophthalmitis have not been conducted, there is a growing body of evidence that shows that the routine use of antibiotics before or after intravitreal injections should be discouraged.3, 4, 5 It is noteworthy that the use of pre- and/or post-injection antibiotics may still be considered in selected conditions such as eyes with external ocular diseases, nasolacrimal drainage problems, or history of endophthalmitis, as well as monocular patients. Once again we thank Dr Grzybowski for his comments, which have allowed us the opportunity to respond.