Nonsterile Gloves Offer Little Protection Against Post-Injection Endophthalmitis, Study Finds

David Anderson, MD, PharmD
Credit: Retina Consultants of Minnesota

An analysis of nonsterile glove use versus non-use is shedding light on the impact of the practice on the rate of post-injection endophthalmitis among patients receiving anti-VEGF injections for ophthalmic conditions.

Presented at the American Society of Retina Specialists (ASRS) 42nd Annual Meeting, results of the study, which included more than 100,000 injections occurring within a single calendar year, suggest there was a nominal, but no statistically significant difference in the rate of post-injection endophthalmitis based on nonsterile glove use or non-use among retina specialists.¹

“The incidence of endophthalmitis within this retina group is very low, at or below rates published in the literature. This is encouraging considering the diversity in physician injection practices,” wrote investigators.¹

The result of intraocular colonization of infectious agents with exudation within interocular fluids, endophthalmitis is an ophthalmic condition characterized by inflammation of the inner coats of the eye. Due to its association with blindness, many have launched research endeavors attempting to identify best practices for reducing the rate of endophthalmitis.^1,2,3

Although evidence on the topic has proven inconclusive, the use of sterile gloves during ophthalmic procedures, including administration of anti-VEGF injections, has become a common practice for many retina specialist. However, even less conclusive research has been produced examining the risk of post-injection endophthalmitis rates based on nonsterile glove use relative to no glove use.^1,2,3

With this in mind, David Anderson MD, PharmD, of Retina Consultants of Minnesota, and colleagues designed the current study to assess trends according to nonsterile glove use from within their own practice, which includes 19 physicians. The primary outcome of interest for the study was culture positive or clinically definite post-injection infectious endophthalmitis following anti-VEGF class injectables.¹

Of note, specific exclusion criteria required the removal of those with non-injection related endophthalmitis, post-injection intraocular inflammation, and those receiving non-anti-VEGF injections.¹

During 2023, the specific period of interest for the study, 120,373 intravitreal injections were performed and 20 cases of endophthalmitis were reported. Of the 20 cases, 14 (705%) were culture positive. Overall, the event rate for infectious endophthalmitis was 0.0166% or approximately 1 in 6000 injections.¹

Primary outcome analyses revealed an incidence of 0.0123% among those wearing gloves and 0.0215% among those not wearing gloves, which corresponded to event rates of 1 in 8130 and 1 in 4633, respectively. However, investigators noted this nominal difference in incidence failed to reach statistical significance (P = .21498).¹

Further analysis suggested there was no difference in rates of post-injection endophthalmitis between drug products. Additionally, assessment of time spent putting on gloves ranged from 18 minutes and 45 second to 33 minutes per 100 glove pairs, with a mean of 26 minutes and 55 seconds. Based on this data, investigators projected a conservative estimate of 33 hours per year per retina specialist in time spent donning gloves. Investigators also pointed out the carbon footprint of nitrile glove use from this practice alone was estimated at 1296 tons CO2 equivalent.¹

“The use of non-sterile gloves did not significantly reduce the rate of endophthalmitis. Glove use does have other potential impacts such as increasing office time and environmental waste,” investigators concluded.¹

References:

1. Singer M. Phase 2 Population Extension Cohort in the PRISM Trial Evaluating 4D-150 in Adults With Neovascular Age-related Macular Degeneration. Paper presented at the American Society of Retina Specialists (ASRS) 42nd Annual Meeting. Stockholm, Sweden. July 17-20, 2024.
2. Tanaka K, Shimada H, Mori R, et al. Safety Measures for Maintaining Low Endophthalmitis Rate after Intravitreal Anti-Vascular Endothelial Growth Factor Injection before and during the COVID-19 Pandemic. J Clin Med. 2022;11(3):876. Published 2022 Feb 7. doi:10.3390/jcm11030876
3. Singh R, Davoudi S, Ness S. Preventive factors, diagnosis, and management of injection-related endophthalmitis: a literature review. Graefes Arch Clin Exp Ophthalmol. 2022;260(8):2399-2416. doi:10.1007/s00417-022-05607-8