Aqueous Chlorhexidine for Intravitreal Injection Antisepsis: A Case Series and Review of the Literature

Abstract

Purpose: To determine the incidence of endophthalmitis in a large clinical series using aqueous chlorhexidine for antisepsis before intravitreal injection and to review the ophthalmic literature regarding chlorhexidine efficacy and safety.

Design: Multicenter retrospective case series.

Participants: All patients receiving intravitreal injections from 7 retinal specialists.

Methods: An audit of intravitreal injections performed by retinal specialists who exclusively used aqueous chlorhexidine 0.05% or 0.1% for prophylaxis of infective endophthalmitis was undertaken. The incidence of endophthalmitis was determined from August 1, 2011, to February 28, 2015. A literature review was performed to critically appraise the ocular safety and efficacy of aqueous chlorhexidine.

Main outcome measures: Incidence of endophthalmitis after intravitreal injections.

Results: A total of 40 535 intravitreal injections were performed by 7 retinal specialists across 3 centers. Chlorhexidine was well tolerated, and only 1 patient with a suspected allergic reaction was noted. Three cases of endophthalmitis were identified with 1 culture-positive case. The 0.0074% (1 in 13 512) per-injection rate of endophthalmitis in this series compares favorably with previous series in which povidone-iodine has been used.

Conclusions: Aqueous chlorhexidine was associated with a low rate of postinjection endophthalmitis and was well tolerated by patients.