Moss Jason M, Sanislo Steven R, Ta Christopher N
Stanford University Medical Center, Department of Ophthalmology, Stanford, California, USA.
Ophthalmology. 2009 Aug;116(8):1498-501. doi: 10.1016/j.ophtha.2009.02.024. Epub 2009 Jun 5.
We sought to assess the efficacy of 3-day topical gatifloxacin use in combination with povidone-iodine (PVI) versus PVI alone in eliminating conjunctival bacterial flora in patients scheduled to undergo intravitreal (IVT) injection.
Prospective, randomized single-blind clinical trial.
We included 129 patients scheduled to undergo 273 IVT injections at California Vitreoretinal Center at Stanford University.
Study patients were randomized to self-administration of gatifloxacin drops for 3 days before injection, or no pretreatment antibiotics. Cultures were collected from the bulbar conjunctiva at the injection site and at the corresponding location in the fellow eye before PVI preparation. After topical PVI treatment and immediately before injection, a third culture was obtained at the injection site. Additionally, the injection needle was also cultured after the procedure.
Incidence of positive bacterial samples collected from injection site conjunctiva and injection needles.
Three-day gatifloxacin use resulted in a significantly lower rate of SeptiChek (Becton Dickinson, Franklin Lakes, NJ) positive cultures compared with untreated controls (21% vs 48% respectively, P = 0.005). After topical PVI, the rate of positive bacterial cultures in gatifloxacin-treated and control eyes were similar (8% and 4%, respectively; P = 0.324).
Although 3-day topical gatifloxacin use is effective in reducing the frequency of conjunctival bacterial growth relative to untreated eyes, antibiotic use confers no additional benefit in combination with PVI than eyes receiving PVI alone. This supports that topical PVI is an effective preinjection monotherapy for infection prophylaxis in the setting of IVT injections.
我们旨在评估为期3天局部使用加替沙星联合聚维酮碘（PVI）与单独使用PVI相比，在接受玻璃体内（IVT）注射的患者中消除结膜细菌菌群的疗效。
前瞻性、随机单盲临床试验。
我们纳入了129例计划在斯坦福大学加利福尼亚玻璃体视网膜中心接受273次IVT注射的患者。
研究患者被随机分为在注射前3天自行使用加替沙星滴眼液组或不进行抗生素预处理组。在制备PVI前，从注射部位的球结膜以及对侧眼的相应位置采集培养物。局部使用PVI治疗后且在注射前即刻，在注射部位获取第三次培养物。此外，在操作后也对注射针进行培养。
从注射部位结膜和注射针采集的细菌样本阳性发生率。
与未治疗的对照组相比，使用3天加替沙星导致SeptiChek（BD公司，新泽西州富兰克林湖）阳性培养率显著降低（分别为21%和48%，P = 0.005）。局部使用PVI后，加替沙星治疗组和对照组的细菌培养阳性率相似（分别为8%和4%；P = 0.324）。
尽管相对于未治疗的眼睛，使用3天局部加替沙星可有效降低结膜细菌生长频率，但与单独接受PVI的眼睛相比，抗生素联合PVI并无额外益处。这支持局部使用PVI是IVT注射时预防感染的一种有效的注射前单一疗法。
