Conjunctival Flora Patterns After Serial Intravitreal Injections in Diabetic Patients
Conjunctival Flora Patterns After Serial Intravitreal Injections in Diabetic Patients
The aim of this study is to investigate the conjunctival bacterial flora and antibiotic
 resistance patterns following serial intravitreal injections of anti-VEGF in diabetic
 patients, using a povidone-iodine preparation without preinjection or postinjection topical
 antibiotics.
The study is designed to enroll patients with Diabetes Mellitus over 18 years of age with
 diagnosis of diabetic retinopathy and diabetic macular edema, who were determined by their
 treating physician to require at least 3 serial injections with an anti-VEGF agent.

 After signing an informed consent, conjunctival cultures will be performed from the
 participants' both eyes at baseline and at each subsequent injection. Prior to each injection
 and the use of povidone-iodine drops, a conjunctival culture will be taken by swabbing the
 inferior fornix. Another culture will be taken twenty minutes after the injection. We will
 culture the swab samples on blood and chocolate agar plates.

 All patients will be asked to complete a questionnaire regarding their signs and symptoms
 after the injection (like burning sensation, itching, discharge, tearing etc). The following
 routine procedure will be used in all intravitreal injections: local anesthesia using
 Oxybuprocaine hydrochloride, ocular surface and eyelids sterilization with topical
 povidone-iodine 4%. Intravitreal injection of 3.5 mm will be performed posterior to the
 limbus in pseudophakic patients and 4 mm injection will be performed posterior to the limbus
 in phakic patients using a 30 gauge needle.

 The exclusion criteria will consist patients who had received a prior intraocular injection
 in either eye, current use of contact lenses, chronic use of any ophthalmic medication,
 ocular surgery within the past 6 months, use of systemic antibiotics within the past 6 months
 and known allergy or contraindication to povidone-iodine or proparacaine.

 The study is planned to enroll 50 patients.
Inclusion Criteria:

 -  age above 18

 -  patients with diabetes mellitus

 -  patients with diabetic macular edema

 Exclusion Criteria:

 -  patients who had received a prior intraocular injection in either eye,

 -  current use of contact lenses,

 -  chronic use of any ophthalmic medication,

 -  ocular surgery within the past 6 months,

 -  use of systemic antibiotics within the past 6 months,

 -  known allergy or contraindication to povidone-iodine or proparacaine.