In 2004 the committee did not come to a consensus on routine use of pre-, peri- or postinjection antibiotics. Since then evidence has emerged suggesting that peri-injection antibiotics do not meaningfully lower the risk of post-injection infection and periodic multi-day administration of topical ophthalmic antibiotics facilitates the colonization of drug-resistant bacteria. For these reasons in 2014 the committee decided against recommending routine antibiotics. The new guidelines include hand washing and glove use consistent with the modern-day medical practice of universal precautions. Although the use of gloves was agreed upon by the committee some panelists cited studies showing no impact of glove use on endophthalmitis rate. In 2004, the topic of droplet contamination was not addressed. Since then new evidence has come to light showing that streptococcal species cause a disproportionate number of post intravitreal injection endophthalmitis cases compared to other forms of ocular surgery. This is likely due to aerosolized droplet contamination from either the practitioners’ or patients’ mouth. The 2014 guidelines were updated to address these findings recommending both clinicians and patients wear face masks during the procedure. The new guidelines recommend monitoring intraocular pressure both pre- and post-injection. This recommendation stemmed from new evidence showing that routine intravitreal administration of anti-VEGF therapies may increase intraocular pressure for a sustained time period. The 2014 guidelines addressed bilateral injections done in the same visit. The committee recommended treating each eye as a separate procedure and use different lots or batches of medication whenever possible. The panel was not able to support the use of sterile drapes in the procedure as retrospective studies showed no increased rate of endophthalmitis in injections done without drapes. Potential alternatives Intravitreal injections have vastly improved outcomes for patients with retinal diseases however the risk and patient burden associated with repeated injections has prompted researchers to pursue less invasive methods of application. There has been significant emphasis on finding methods to administer treatments topically over the last 50 years. This research has garnered more attention thanks to the increase in intravitreal injections and the growing evidence linking repeat injections to adverse events. See also Eye drops References Medical treatments Ophthalmic drug administration