Patient comfort and using chlorhexidine for anti-sepsis

Sunir Garg, MD, a professor of ophthalmology at Wills Eye Hospital and partner with Mid-Atlantic Retina, discussed with Modern Retina one significant challenge in ophthalmological procedures: patient discomfort during intravitreal injections caused by povidone iodine.

While povidone iodine is crucial for reducing infection risks, approximately half of patients experience significant eye irritation and burning, which can discourage them from continuing treatment, especially when some treatments are scheduled to be administered every month or every other month. To address this issue, Garg explored chlorhexidine as an alternative anti-sepsis method.

Chlorhexidine, traditionally used in surgical settings, exists in 2 primary formulations: an alcohol-based version and an alcohol-free variant. The alcohol-based version can be harmful to the cornea, while the alcohol-free version presents cost and practicality challenges. Commercially available bottles have a 24-hour usability requirement and cost around $100, making them economically impractical.

To evaluate chlorhexidine's potential, Garg and his fellow researchers conducted a stability study with a pharmacy professor. Using advanced techniques like high-performance liquid chromatography and turbidity testing, they discovered that the chlorhexidine molecule remains chemically identical after 30 days at room temperature. This finding suggests that larger bottles can be aliquoted and used cost-effectively throughout a month.

Patient experiences with chlorhexidine have been predominantly positive. Those who previously dreaded injections due to discomfort reported significantly reduced irritation. Garg shared an anecdote about a patient who was initially skeptical that she had received her injection because she experienced none of the typical pain or burning during her injection. The research indicates that while some patients tolerate povidone iodine well, others find chlorhexidine a game-changing alternative.

The study provides preliminary evidence supporting chlorhexidine as a potentially superior antisepsis method in ophthalmological procedures. Future research goals include conducting larger studies to definitively demonstrate chlorhexidine's non-inferiority to povidone iodine and exploring more cost-effective implementation strategies. The ultimate aim is to improve patient comfort and treatment compliance by minimizing procedural discomfort during intravitreal injections.