Trends in Endophthalmitis Associated With Intravitreal Injection of Anti-VEGF Agentsat a Tertiary Referral Center

Abstract

BACKGROUND AND OBJECTIVE: To report the incidence and clinical features of infectious endophthalmitis after intravitreal (IV) injection of anti-vascular endothelial growth factor inhibitors (VEGF) between 2018 and 2020 and to compare to prior rates. PATIENTS AND METHODS: Retrospective analysis of patients with endophthalmitis after anti-VEGF IV injections treated at Bascom Palmer Eye Institute between January 1, 2018, and December 31, 2020. RESULTS: Between 2018 and 2020, the rate of clinically diagnosed endophthalmitis was 0.014% (10/71,858) and of culture-positive was 0.008% (6/71,858). Clinically diagnosed endophthalmitis rates per injection were: aflibercept (0.022%); ranibizumab (0.019%); bevacizumab (0%); and brolucizumab (0%). Clinically diagnosed endophthalmitis rates were similar in the present study compared to those from 2005 to 2017 ( P = .84). Fifteen eyes were diagnosed with endophthalmitis (10 in-house, five external referrals). Of culture-positive eyes, the organisms were coagulase-negative Staphylococcus (8/11), Streptococcus species (2/11), and Abiotrophia defectiva (1/11). A universal face-masking policy in 2020 did not lower infection rates ( P = .73). CONCLUSION: Endophthalmitis rates after IV anti-VEGF remain low and are similar to prior reports. [ Ophthalmic Surg Lasers Imaging Retina . 2021;52:319–326.]

Incidence of Acute Endophthalmitis after Intravitreal Antivascular Endothelial Growth Factor Injection in Age-related Macular Degeneration

“…The incidence of endophthalmitis in our study differed in comparison with the findings reported in previous studies, which seems to be mainly related to differences in study design, patient characteristics, and the definition of endophthalmitis. In a 2-year single-center retrospective study, the incidence of clinically diagnosed endophthalmitis was reported to be 0.014%, which is consistent with our study [ 12 ]. However, another 4-year multicenter retrospective study found that the incidence of presumed infectious endophthalmitis was much higher (0.04%) [ 7 ].…”

“…In a study using US claims data, the incidence of antibiotic-associated endophthalmitis was higher with aflibercept than with ranibizumab (0.44% vs. 0.22%), and the risk of developing endophthalmitis was also higher with aflibercept (adjusted relative ratio, 2.04; 95% CI, 1.42–2.92; p < 0.05) [ 14 ]. However, some studies showed no statistically significant differences in the incidence of endophthalmitis by medication type [ 12 , 15 , 16 ].…”

Endophthalmitis aus ophthalmopathologischer Sicht

“…Die Inzidenz der postoperativen Endophthalmitis (ohne intravitreale Injektionen) wird zwischen 0,05 % und 0,09 % angegeben [1,2]. Die Endophthalmitisrate nach intravitrealer Injektion liegt zwischen 0,008 % und 0,077 % [3,4]. Aufgrund der hohen Anzahl an Kataraktoperationen und intravitrealen Injektionen beobachtet man eine Endophthalmitis postoperativ hier zahlenmäßig häufiger, auch wenn der prozentuale Anteil (Kataraktoperation: 0,04 % bzw.…”

“…Aufgrund der hohen Anzahl an Kataraktoperationen und intravitrealen Injektionen beobachtet man eine Endophthalmitis postoperativ hier zahlenmäßig häufiger, auch wenn der prozentuale Anteil (Kataraktoperation: 0,04 % bzw. 0,08 % [1,2]; intravitreale Injektionen 0,014 % [3]) unter der Inzidenz derer bei perforierender Keratoplastik (0,08 % bzw. 0,178 % [1,2]) und Glaukomoperationen (0,2 % bzw.…”

“…Grundsätzlich kann in einem gewissen Anteil von Endophthalmitiden erst gar kein Keim nachgewiesen werden. Bei einer Studie zum Auftreten einer Endophthalmitis nach intravitrealer Injektion, die mit einer Inzidenz von 0,014 % auftraten, zeigte sich lediglich in 6 von 10 Fällen (0,008 %) ein positiver Keimnachweis [3]. Auch die Abgrenzung einer sterilen, also nicht infektiösen intraokularen Entzündung ist nicht immer einfach.…”