Intravitreal injections: Guidelines to minimize the risk of endophthalmitis

Intravitreal injection was reported by Ohm in 1911 as a technique to introduce air for retinal tamponade and repair of retinal detachment [28]. Intravitreal administration of pharmacotherapies dates to the mid-1940s with the use of penicillin to treat endophthalmitis [34, 35]. Since that time, use of the intravitreal injection technique has steadily increased, with its usage being focused primarily on the treatment of retinal detachment [7, 32], endophthalmitis [8, 31], and cytomegalovirus (CMV) retinitis [13, 43]. The increasing confidence in the efficacy and safety of intravitreal injections, in conjunction with the development of additional pharmacotherapies, has led to a recent rapid increase in the use of this technique for the administration of various pharmacotherapies (e.g., ranibizumab [6], pegaptanib sodium [9, 41, 42]) for age-related macular degeneration (AMD) and intravitreal triamcinolone for macular edema associated with a variety of etiologies, such as diabetic retinopathy [21], central retinal vein occlusion [10, 36], branch retinal vein occlusion [5, 17, 30, 37], uveitis [2, 44], and birdshot retinochoroidopathy [22].