Share The first question asked in clinical trials, even before, "does it work?", would be the important, "is it safe?".  After years of use and thousands of injections, the treatment for wet macular degeneration (Lucentis or Avastin) is generally safe.  But an infection developed during treatment could be disastrous. The most frightening possibility for any intravitreal eye injection is a severe infection called endophthalmitis.  If bacteria is introduced within the eye, it can cause major complications, including blindness or loss of the eye.

Over years of use, clinicians have learned the best techniques to avoid eye infections and the rate of them is extremely low now.  Sterile technique and wearing gloves has something to do with this.  Yet, people do still get these infections.

Researchers at Jules Stein Eye Institute at UCLA have tracked a pathway to infection that may have been overlooked.  They simulated an eye injection but in place of a person in the exam chair, they used a culture plate where the patient's face would be.

Volunteers playing the role of the doctor stood in front of the chair.  In one group, the volunteers read from a script for 5 minutes; then, they were completely silent for five minutes.  Some of them directly faced the "patient" - wearing a mask or not wearing a mask.  Others turned their heads sideways and did not wear a mask.

Next, they conducted the same experiment - but this time, a volunteer sat in the chair, spoke from a script and wore the culture plate attached to his/her forehead.  These "patients" did not wear a mask.

In the cases where there was silence or the volunteers used a mask, very little bacteria grew on the culture plate.  But, when they didn't wear a mask, most of the plates grew bacteria.

Your doctor probably wears a mask to give intravitreal injections. But, do you or others in the room chat away during the procedure?  When the volunteers sat in the chair and talked, about half of the plates grew bacteria.

When you talk, your mouth pushes bacteria out into the room (and some of it drifts back at you).  If your doctor is putting a tiny hole in your eye, you might want to hold your comments until the procedure is finished.

This was a small experiment, but it seems reasonable to reduce your chance of infection by keeping your eyes open but your mouth closed.

August 2011