Purpose: Epiretinal proliferation is a distinct clinical entity from epiretinal membrane that is classically associated with lamellar macular holes, but its prevalence and association with full-thickness macular holes (FTMH) have not been well described. We characterize MHEP macular hole associated epiretinal proliferation (MHEP) and its effects on long-term surgical outcomes. Design: Multi-center, interventional, retrospective case control study. Subjects: Consecutive eyes that underwent surgery for FTMH with a minimum of 12-months follow-up. Methods: All eyes underwent pars plana vitrectomy, removal of any epiretinal membranes, and gas tamponade, with or without internal limiting membrane peeling. Spectral domain optical coherence tomography imaging was obtained pre- and post-operatively. Main Outcome Measures: Improvement in visual acuity and single surgery hole closure rates in eyes with, versus without, MHEP at 12 months. Results: 725 charts were analyzed, and 113 patients met inclusion criteria. Of 113 eyes with FTMH, 30 (26.5%) had MHEP. Patients with FTMH and MHEP were older (P < 0.002), more often male (P = 0.001), and with more advanced macular hole stages than those without MHEP (P = 0.010). A full posterior vitreous detachment was more common in eyes with MHEP (P < 0.004). FTMH with MHEP had significantly less improvement in visual acuity 12-months postoperatively (P = 0.019) with higher rates of ellipsoid and external limiting membrane defects (P < 0.05) and with a higher rate of failure to close with one surgery compared to FTMH without MHEP (26.7% versus 4.8% [P = 0.002]). Peeling the internal limiting membrane was associated with improved rates of hole closure in FTMH with MHEP (P < 0.001). Multivariable testing confirmed that the presence of MHEP was an independent risk factor for less visual improvement (P = 0.031), single-surgery non-closure (P = 0.009), and that ILM peeling improved single-surgery closure rates (P = 0.026). Conclusions: We found that FTMH with MHEP has poorer anatomic and visual outcomes after vitrectomy compared to FTMH without MHEP. ILM peeling was associated with improved closure rates and should be considered when MHEP is detected preoperatively.

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Purpose: To determine the incidence of endophthalmitis following anti-vascular endothelial growth factor (VEGF) therapy at our institution and to identify potential risk factors for post-injection endophthalmitis Design: Retrospective, single center cohort study Participants: All patients who received an intravitreal injection of an anti-VEGF medication between January 1, 2014 and March 31, 2017. Methods: Current Procedural Terminology and International Classification of Diseases billing codes were used to identify instances of anti-VEGF administration and cases of endophthalmitis. Medical records and injection technique were carefully reviewed in each case. Multivariable logistic regression analysis was performed in a stepwise fashion to determine independent predictors of endophthalmitis based on injection protocol. Main Outcome Measures: Incidence of post-injection endophthalmitis and odds of endophthalmitis by injection technique with 95% confidence intervals (CI). Results: A total of 154,198 anti-VEGF injections were performed during the time period of interest, resulting in 58 cases of endophthalmitis (0.038%, 1:2,659). After adjustment for confounders, both 2% lidocaine jelly (OR = 11.28, 95% CI: 3.39 – 37.46, p < 0.001) and 0.5% Tetravisc (OR = 3.95, 95% CI: 1.15 – 13.50, p = 0.03) use were independent risk factors for post-injection endophthalmitis. Lid speculum use, povidone iodine strength (5% vs. 10%), injection location (superior or inferior), conjunctival displacement, use of provider gloves, employment of a strict no-talking policy, use of subconjunctival lidocaine, and topical antibiotic use were not statistically significant predictors of post-injection endophthalmitis. There was no difference in endophthalmitis rate among the anti-VEGF agents (bevacizumab, ranbizumab 0.3 mg, ranibizumab 0.5 mg, and aflibercept). Conclusion: The incidence of endophthalmitis after anti-VEGF injections is low. Use of lidocaine jelly or Tetravisc may increase the risk of post-injection endophthalmitis.