Materials and Methods: This is a cross sectional, prospective, case-control study. Patients undergoing intravitreal injections for retinal diseases were randomized in two groups; in Group A, the eyelids were opened with a lid speculum and in Group B, the eyelids were retracted with manual assistance. Following sample collection for microbiological evaluation, the procedure was completed in the conventional route in both groups. The groups were compared by means of demographics, diagnosis, laterality and microbiological outcome.

Results: There were 30 patients in each group. The patients had either neovascular age related macular degeneration or diabetic macular edema. The agent administered was either afl ibercept or ranibizumab. The mean age was 65.9 ± 10.6 and the male/female ratio was 32/28. There was no signifi cant difference in age, gender, diagnosis, laterality or the agent administered between groups. The manual retraction technique was associated with less culture positive cases compared to speculum (19 vs. 22, p=0.580). The culture positivity rate was signifi cantly higher in male patients (p=0.028). No endophthalmitis or ocular adverse events were encountered.

Conclusion: Manual-assisted eyelid retraction for intravitreal injections offers improved microbiological outcome. Keywords : Conjunctival culture; endophthalmitis; intravitreal injections; lid speculum; manual lid retraction