Endophthalmitis Rates after Bilateral Same-Day Intravitreal Anti–Vascular Endothelial Growth Factor Injections

Borkar, Durga S.; Obeid, Anthony; Su, Daniel; Storey, Philip; Gao, Xinxiao; Regillo, Carl D.; Kaiser, Richard; Garg, Sunir J.; Hsu, Jason; Chiang, Allen; Dunn, James P.; Fineman, Mitchell S.; Fischer, David H.; Gupta, Omesh P.; Ho, Allen C.; Klufas, Michael A.; Maguire, Joseph I.; Mehta, Sonia; Park, Carl; Sivalingam, Arunan; Spirn, Marc J.; Tasman, William; Vander, J.F.

doi:10.1016/j.ajo.2018.06.022

Cited by 39 publications

(22 citation statements)

References 30 publications

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“…Many retinal specialists are uncomfortable to perform concomitant bilateral anti-VEGF injections fearing a higher risk of endophthalmitis. In this study, the incidence of endophthalmitis was 0.01% (1 case in 9,798 injections), which is near the lower end of the range described by previous reports (0.0–0.065%) [13-18, 20]. Our study described a similar incidence while involving as much injections (9,798) as some large clinical trials that have assessed the efficacy and safety of anti-VEGF therapy.…”

Section: Discussionsupporting

confidence: 81%

“…In the MARINA study, for example, there were 5 cases of presumed endophthalmitis after 10,443 injections (0.05%) [21] and, in the meta-analysis published by McCannel, the cumulative rate of endophthalmitis was 0.049% [11]. Recently, Borkar et al [20] have also recently encountered a low rate (0.027%) of endophthalmitis in the largest reported cohort of patients undergoing bilateral anti-VEGF injections.…”

Section: Discussionmentioning

confidence: 99%

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Same-Day Bilateral Intravitreal Anti-Vascular Endothelial Growth Factor Injections: Experience of a Large Canadian Retina Center

et al. 2019

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Objective: To evaluate the outcomes and complications of bilateral same-day intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. Methods: This is a single-center, retrospective study that included 524 eyes of 262 patients who received concomitant bilateral intravitreal anti-VEGF injections in 2016 at St. Michael’s Hospital, Toronto. If any of the patients were receiving simultaneous bilateral injections on a regular basis prior to 2016, data pertaining to previous injections were also reviewed. Everyone received bevacizumab, ranibizumab, or aflibercept in an office setting. Results: A total of 9,798 intravitreal anti-VEGF injections (4,899 bilateral injection sessions) were performed in 524 eyes of 262 patients. The average number of bilateral injection sessions per patient was 18.7 ± 14.1. Ranibizumab was the most commonly used anti-VEGF drug (83.8%). The incidence of endophthalmitis was 0.01%, and there were 2 episodes of acute intraocular inflammation among the 9,798 injections (0.02%). All 3 cases occurred after treatment with ranibizumab. There were 2 deaths (0.76%) due to nonvascular causes but no vascular related systemic adverse events were reported. Conclusions: Same-day bilateral intravitreal anti-VEGF injections present a low rate of complications and are well tolerated by patients. This safe practice may reduce the burden on the health-care system and on the patients.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Same-Day Bilateral Intravitreal Anti-Vascular Endothelial Growth Factor Injections: Experience of a Large Canadian Retina Center

et al. 2019

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“…O uso de uma agulha de calibre e comprimento adequados é importante para garantir conforto e segurança ao procedimento. Há evidências de que o calibre de 30 gauge ou mais fino está relacionado a um maior conforto para o paciente, assim como menor risco de refluxo vítreo na incisão [67][68][69] . É considerado o calibre ideal pelos principais guidelines 14,15 e recomendado na bula dos principais medicamentos intravítreos administrados na prática oftalmológica.…”

Section: Técnicaunclassified

Protocolo de injeções intravítreas do Hospital de Clínicas de Porto Alegre: uma revisão de condutas para uma assistência mais qualificada

Falavigna¹,

Scheid²,

Lavinsky³

et al. 2021

CBR

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A injeção intravítrea é o procedimento oftalmológico mais realizado no mundo. Através dessa técnica é possível administrar medicamentos para o segmento posterior do olho, sendo a via de escolha para o tratamento da maioria das patologias coriorretinianas. O evento ocular adverso mais grave é a endoftalmite pós injeção. Diversas medidas foram sugeridas para diminuição do risco dessa complicação, com evidências variáveis. Tendo em vista o grande número de injeções realizado em nosso serviço de oftalmologia do Hospital de Clínicas de Porto Alegre (HCPA), realizamos uma revisão da literatura com o objetivo de definir as melhores práticas. Nós descrevemos a evidência disponível para os principais aspectos dos diferentes estágios do procedimento (pré injeção, peri injeção e pós injeção) e apresentamos nosso protocolo. A medida com maior evidência científica na profilaxia da endoftalmite é a aplicação de iodopovidona tópica pelo menos trinta segundos antes da injeção.

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“…Intravitreal injections (IVI) have become the most common intraocular procedure worldwide with increasing numbers every year (88). In several studies based on bilateral same-day intravitreal anti-VEGF injections, there were no cases of bilateral endophthalmitis, and the overall rate of unilateral endophthalmitis was low and comparable to prior studies of unilateral injections (89,90). The Euretina expert consensus panel recommended to treat each eye sequentially, and not reusing equipment such as the lid speculum or gloves (88).…”

Section: Other Simultaneous Bilateral Ocular Surgeriesmentioning

confidence: 99%

Evolution of and developments in simultaneous bilateral cataract surgery. Update 2020

Singh¹,

Grzybowski²

2020

Ann Transl Med

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The debate on role of 'simultaneous bilateral cataract surgery' (SBCS) continues. The world population has exponentially increased during last fifty years and average human lifespan has increased by a decade during the last century. This translates to ever increasing geriatric population with its inherent problem of preventable blindness because of cataract formation in the elderly. We are adding to the backlog of cataract surgeries not only in the 'developing world' but also in the 'developed world.' Times demand that we reconsider our old fashioned approach of staggering bilateral cataract surgeries. Serious, but a potential, risk of simultaneous bilateral infection/endophthalmitis has been the biggest deterrent in acceptance of SBCS as a routine procedure. The opponents of SBCS strongly believe in this argument that has not been documented when strictly followed the recommendations regarding separate procedures of each eye. The advantages of reducing the ever-increasing backlog of preventable/treatable blindness, faster visual recovery, economic benefits to patients as well as health care providers, lesser risk of amblyopia in pediatric population, and decreased risk of as serious a complication as death by exposure to general anesthesia in pediatric and adult population, etc. outweigh the disadvantages of SBCS when compared with 'delayed bilateral cataract surgery' (DBCS). SBCS is favored over DBCS in pediatric population and in uncooperative, mentally retarded and physically disabled adults needing general anesthesia to reduce the risks and complications of general anesthesia. Considering such factors and review of available literature strongly support that SBCS has a definite role where indicated, under certain circumstances, and in certain select group of patients in both developing as well as developed countries.

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Endophthalmitis Rates after Bilateral Same-Day Intravitreal Anti–Vascular Endothelial Growth Factor Injections

Cited by 39 publications

References 30 publications

Same-Day Bilateral Intravitreal Anti-Vascular Endothelial Growth Factor Injections: Experience of a Large Canadian Retina Center

Same-Day Bilateral Intravitreal Anti-Vascular Endothelial Growth Factor Injections: Experience of a Large Canadian Retina Center

Protocolo de injeções intravítreas do Hospital de Clínicas de Porto Alegre: uma revisão de condutas para uma assistência mais qualificada

Evolution of and developments in simultaneous bilateral cataract surgery. Update 2020

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