Comparative Risk of Endophthalmitis After Intravitreal Injection With Bevacizumab, Aflibercept, and Ranibizumab

Bavinger, J. Clay; Yu, Yinxi; VanderBeek, Brian L.

doi:10.1097/iae.0000000000002351

Cited by 32 publications

(40 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More importantly however, even after accounting for this temporal change, compounded bevacizumab still conferred a protective effect compared to office-loaded syringes. 2 Baudin et al and our studies also found a 29% and 30% increased risk of endophthalmitis in women, repsectively. 1,2 These represent the first reports linking gender to endophthalmitis rates.…”

supporting

confidence: 80%

“…2 Baudin et al and our studies also found a 29% and 30% increased risk of endophthalmitis in women, repsectively. 1,2 These represent the first reports linking gender to endophthalmitis rates. Interestingly, despite age, gender and race almost uniformly being controlled for in other ophthalmic assessments (even when no demonstrable link exists to do so), gender has often been over-looked with regards to endophthalmitis after intravitreal injections.…”

supporting

confidence: 80%

“…The higher rates of endophthalmitis for office-loaded injections compared to pre-packaged agents offer the broadest and most significant policy implication. 1,2 Pre-loaded syringes became a significant issue in the U.S. in 2015 when a couple of highly publicized epidemics of endophthalmitis were found to be related to poor compounding practices of bevacizumab. To address this, the US Food and Drug Administration proposed to institute "beyond-usedates" on compounded medications that would have prevented proper sterility testing of the post-compounded product.…”

mentioning

confidence: 99%

“…Two recent studies have provided several new interesting findings that further our understanding of the risk factors associated with post-injection endophthalmitis. 1,2 While these findings are novel to many of us, it is possible Genentech suspected this issue would arise as they have already received FDA approval and distributed pre-packaged syringes for both their 0.5mg(October 2016) and 0.3mg(March, 2108) doses of ranibizumab. Together, these studies offer compelling evidence that a policy mandating the sterile packaging of all intravitreal injections needs to be strongly considered.…”

mentioning

confidence: 99%

See 3 more Smart Citations

The Argument for Sterile Loading of All Intravitreal Injections and the Benefit of Replicated Results

VanderBeek

2019

JAMA Ophthalmol

Self Cite

View full text Add to dashboard Cite

Recently two studies from different countries using different datasets reported remarkably similar findings with regards to risk of endophthalmitis after intravitreal injections of antivascular endothelial growth factor(anti-VEGF) agents. The first study, published in JAMA Ophthalmology by Baudin and colleagues was conducted using the French national medicaladministrative database covering roughly 66 million people from 2012-2015. 1 They found that factory prepared syringes of ranibizumab decreased endophthalmitis compared to office prepared injections(ranibizumab IRR:1.40 & aflibercept IRR=1.46). 1 Less than a month later, we published a second study in the journal Retina using a similar sized U.S. insurance database covering the years 2005-2016, finding that using office-filled ranibizumab and aflibercept increased the odds of endophthalmitis(OR=1.29) compared to sterilely compounded bevacizumab. 2 Baudin et al. also found a similarly increased post-injection risk of endophthalmitis for women compared to men(IRR=1.28) as our paper did(OR=1.30). 1,2

show abstract

supporting

confidence: 80%

supporting

confidence: 80%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

The Argument for Sterile Loading of All Intravitreal Injections and the Benefit of Replicated Results

VanderBeek

2019

JAMA Ophthalmol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Large, prospective, industry-sponsored trials on more than 7000 intravitreal anti-VEGF injections have found the incidence to range from 0.05% to 0.09%. 16,17 A recent large retrospective study using nationwide medical claims data on more than 1 million anti-VEGF injections reported an incidence of 0.035%, 18 whereas smaller studies at a single institution have yielded higher incidences of 0.10%. 11 Most data on postinjection endophthalmitis have been collected from institutions where attending surgeons perform all procedures, with only a few studies analyzing institutions where trainees play a role in performing injections.…”

Section: Discussionmentioning

confidence: 99%

Risk of Infectious Endophthalmitis From a Resident-Performed Intravitreal Injection

Da-y

Law

Lindsey

2020

Journal of VitreoRetinal Diseases

View full text Add to dashboard Cite

Purpose: This work assesses the safety of resident-performed intravitreal injections by comparing the incidence of postinjection endophthalmitis associated with residents vs surgical retina attendings. Methods: In this retrospective noninferiority cohort study, the Current Procedural Technology code for an intravitreal injection was used to identify patients from July 1, 2015, to October 31, 2018, at a single-center Veterans Affairs hospital where patients receive intravitreal injections from attending vitreoretinal surgeons and residents. The medical record for each injection was reviewed for the training level of the proceduralist, indication, medication, and laterality. The main outcome was the incidence of postinjection endophthalmitis occurring within 30 days of an intravitreal injection, which was confirmed by at least 2 medical-record reviewers. Results: In this cohort of 593 patients, most were male (97.0%), and the average age was 70.3 years (±10.8 years). Of the 6934 injections given, 3877 (55.9%) were performed by residents and 3057 (44.1%) by attendings. Of the 5 cases of endophthalmitis identified, 3 were associated with a resident-performed injection in his or her fourth year of postgraduate training. The difference (0.012%; 95% CI, –0.168% to 0.169%) in the incidence of postinjection endophthalmitis between residents (0.077%) and attendings (0.065%) did not cross the predetermined noninferiority limit (0.200%). Conclusions: At our teaching clinic, resident-performed injections were not associated with an elevated risk of endophthalmitis when compared with attending-performed injections. Under varying levels of supervision, residents appeared to demonstrate appropriate sterile injection technique.

show abstract

Safety of Receiving Anti–Vascular Endothelial Growth Factor Intravitreal Injection in Office-Based vs Operating Room Settings

Sun

Min

et al. 2021

JAMA Ophthalmol

View full text Add to dashboard Cite

IMPORTANCECompared with the operating room (OR), office-based intravitreal injection (IVI) is considered a more cost-effective and convenient approach, yet clinical outcomes of IVIs with anti-vascular endothelial growth factor (VEGF) agents in different settings (office-based vs OR) have not been systematically evaluated.OBJECTIVE To evaluate the safety outcomes of IVI with anti-VEGF agents in the OR vs office-based setting.DATA SOURCES PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched from inception to July 2020.STUDY SELECTION Eligible studies reporting on patients who received IVIs with anti-VEGF drugs with a clearly stated injection setting of the office or OR.DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened studies, extracted data, and assessed risk of bias. A meta-analysis was conducted to determine the rates of endophthalmitis (EO) and culture-positive EO. MAIN OUTCOMES AND MEASURESRates of EO and culture-positive EO following anti-VEGF IVIs in the OR and office-based setting.RESULTS Thirty-one studies with a total of 1 275 815 injections were included. Comparative analysis suggested no difference between rates of EO after IVIs performed in the office and OR settings (odds ratio, 3.06; 95% CI, 0.07-139.75; P = .57; I 2 = 80%) were identified, yet a higher rate of culture-positive EO was found in the office setting (odds ratio, 21.52; 95% CI,; P = .006; I 2 = 0%). The pooled rates of EO following anti-VEGF IVIs were 0.03% (95% CI, 0.03-0.04) and 0.02% (95% CI, 0.01-0.04) in office and OR settings, respectively, and the pooled rates of culture-positive EO were 0.01% (95% CI, 0.01-0.02) and 0.01% (95% CI, 0-0.02). The pooled rates of other ocular and systemic adverse events were low. CONCLUSIONS AND RELEVANCEThe rate of clinically suspected or culture-positive EO following anti-VEGF IVIs was low whether the procedure was performed in the office or OR setting. Bacterial spectrum could differ between the 2 settings. This meta-analysis could not determine if it is more appropriate to give treatment in the OR for safety reasons in low-income compared with higher-income regions in the world.

show abstract

Comparative Risk of Endophthalmitis After Intravitreal Injection With Bevacizumab, Aflibercept, and Ranibizumab

Cited by 32 publications

References 28 publications

The Argument for Sterile Loading of All Intravitreal Injections and the Benefit of Replicated Results

The Argument for Sterile Loading of All Intravitreal Injections and the Benefit of Replicated Results

Risk of Infectious Endophthalmitis From a Resident-Performed Intravitreal Injection

Safety of Receiving Anti–Vascular Endothelial Growth Factor Intravitreal Injection in Office-Based vs Operating Room Settings

Contact Info

Product

Resources

About