Endophthalmitis After Intravitreal Anti–vascular Endothelial Growth Factor Antagonists

Abstract

A very low rate of endophthalmitis after intravitreal injections of anti-vascular endothelial growth factor agents was observed. Patients typically presented within 3 days of injection. Streptococcus species was the most common bacteria isolated, and it was generally associated with poor visual outcomes.

Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature

“…10,11 However, the reported rate in the recent studies tends to be lower than that in early trials. [10][11][12][13][14][15][16] The rate of endophthalmitis seems to be the same among different anti-VEGF agents, 12 different injection settings, 15 and different geographical locations. 17 Recent studies reported that endophthalmitis caused by Streptococcus species was significantly more frequent after intravitreal injection than after intraocular surgery.…”

Post-intravitreal anti-VEGF endophthalmitis in the United Kingdom: incidence, features, risk factors, and outcomes

“…28 The incidence rate found in this study of 0.025% of PIAE is comparable to previous work that has quoted rates ranging from 0.02-0.1%. 9,10,12,[14][15][16][17][18]21,22 This is the largest prospective study to ascertain an incidence rate for PIAE in the UK population when intravitreal anti-VEGF is used to treat exudative ARMD.…”

“…This is in keeping with the most commonly identified pathogens causing endophthalmitis following cataract surgery and other studies analysing PIAE. 21,28,32,33 The most commonly used intravitreal antibiotic combinations used in our study were vancomycin and amikacin or vancomycin and ceftazidime. Such combinations of antimicrobials, specifically vancomycin, are likely to cover the most common causative organisms in PIAE in the same way they would post-cataract endophthalmitis.…”

“…This rate is comparable to or better than other studies of endophthalmitis following intravitreal therapy and cataract surgery. 15,17,18,21,32,33,[35][36][37] As with endophthalmitis following cataract surgery, vitreous sampling achieved a higher organism yield rate compared with aqueous sampling. 28,32,33 However, as aqueous sampling yielded an organism that was not identified by vitreous sampling in two cases, it may be optimal to perform both vitreous and aqueous sampling in the event of PIAE in order to maximise the chance of identifying a causative pathogen.…”

“…[9][10][11][12][13] Following intravitreal injection of anti-VEGF, the incidence of endophthalmitis is thought to be low with rates of between 0.02 and 0.1% previously being reported. 9,10,12,[14][15][16][17][18][19][20][21][22] This is the first UK-wide population-based prospective study to determine the incidence and features of endophthalmitis following intravitreal injection of anti-VEGF therapy and to identify reversible risk factors for endophthalmitis so that reported incidence rates may be reduced.…”