Current Infectious Endophthalmitis Rates After Intravitreal Injections of Anti-Vascular Endothelial Growth Factor Agents and Outcomes of Treatment

Gregori, Ninel Z.; Flynn, Harry W.; Schwartz, Stephen G.; Rosenfeld, Philip J.; Vaziri, Kamyar; Moshfeghi, Andrew A; Fortun, Jorge A.; Kovach, Jaclyn L.; Dubovy, Sander R.; Albini, Thomas A.; Davis, Janet L.; Berrocal, Audina M.; Smiddy, William E.

doi:10.3928/23258160-20150610-08

Cited by 61 publications

(44 citation statements)

References 16 publications

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“…These patients were not evaluated by the EVS. 6-7 This study aimed to evaluate the outcomes of delayed vitrectomy for the sequelae of endophthalmitis in the current environment of advancing surgical techniques and technologies.…”

Section: Discussionmentioning

confidence: 99%

Pars Plana Vitrectomy for Late Vitreoretinal Sequelae of Infectious Endophthalmitis

Thomas

Mehta

Yonekawa

et al. 2017

Retina

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Purpose To report the visual acuity (VA) outcomes after pars plana vitrectomy (PPV) for delayed vitreoretinal sequelae of infectious endophthalmitis. All eyes were initially treated with intravitreal antibiotics (Abx). Methods Multicenter, retrospective, consecutive case series. Results Forty-two eyes met study criteria. The mean follow-up was 48 weeks (SD±61.8). Mean interval from Abx to PPV was 13 weeks (SD±14.3, range 2-70). Indications for PPV included vitreous opacity (VO) (n=22), epiretinal membrane (ERM) (n=9), and retinal detachment (RD) (n=11). LogMAR VA improved from 1.87 (Snellen equivalent: 20/1482) preoperatively to 1.35 (Snellen equivalent: 20/447) at final evaluation (p<0.001). logMAR VA improved significantly for patients with vitreous opacities (P<0.01) and retinal detachment (P=0.02) but not for patients with epiretinal membranes (P=0.08). Conclusions Patients with infectious endophthalmitis can gain vision if they have a PPV for delayed sequelae such as vitreous opacities or for retinal detachment.

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Section: Discussionmentioning

confidence: 99%

Pars Plana Vitrectomy for Late Vitreoretinal Sequelae of Infectious Endophthalmitis

Thomas

Mehta

Yonekawa

et al. 2017

Retina

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“…24 These databases have been previously used to study outcomes of other ophthalmic procedures. 25–28 This search included both the MarketScan and Medicare claims databases. All patients in these databases have unique identifiers, which prevents the possibility of overlap (patients being counted twice).…”

Section: Methodsmentioning

confidence: 99%

Rates of Reoperation and Retinal Detachment after Macular Hole Surgery

et al. 2016

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Purpose To evaluate reoperation rates and to assess the cumulative incidence of retinal detachment (RD) following macular hole surgery. Design Retrospective, cross-sectional study. Subjects Patients included in the insurance claim-based MarketScan databases from the years 2007–2013 with a record of macular hole surgery. Methods Patients with records of macular hole surgery were identified and cases of “definite” (surgeries in which the same eye was coded both times) and “presumed” (surgeries in which the eye laterality was not coded) macular hole reoperations within 2, 3 and 12 months were queried. In addition, cases of postoperative RD occurring within 2, 3, and 12 months were captured. Main Outcome Measures Rates of macular hole reoperation and RD following macular hole surgery, including subgroup analysis based on presence or absence of internal limiting membrane (ILM) peeling. Results Records of 23,465 macular hole surgeries among 20,764 patients were analyzed. Among ‘presumed’ reoperations, the rates of reoperation were 4.3% (4.1% following ILM peeling and 5.0% following no ILM peeling; P=0.01) within 2 months of the initial surgery, 5.5% (5.3% following ILM peeling and 6.2% following no ILM peeling; P=0.03) within 3 months and 9.5% (9.0% following ILM peeling and 11.0% following no ILM peeling; P=0.01) within 12 months. The rates for ‘definite’ reoperations were 1.3% (1.2% following ILM peeling and 1.8% following no ILM peeling; P=0.04) at 2 months, 1.7% (1.6% following ILM peeling and 2.5% following no ILM peeling; P=0.004) at 3 months and 4.1% (3.3% following ILM peeling and 7.5% following no ILM peeling; P<0.001) at 12 months. The cumulative incidence rate of postoperative RD was 1.81 ± 0.09% to 2.18 ± 0.5% after 2 months, 2.27 ± 0.10% to 3.18 ± 0.67% after 3 months and 3.92 ± 0.16% to 5.70 ± 1.1% after 12 months. ILM peeling was negatively associated with postoperative RD at 2 months (2.3% vs. 1.7%; P=0.007), 3 months (2.8% vs. 2.1%; P=0.004) and 12 months (4.7% vs. 3.3%; P<0.001). Conclusions In this large and nationally representative sample, reoperations for macular hole were performed at low rates. ILM peeling was associated with lower rates of reoperation and RD.

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“…One institution reported an incidence of 6 endophthalmitis events after ranibizumab (0.018%) and 6 endophthalmitis events after aflibercept (0.031%) per 121,285 injections. 45 Endophthalmitis was found in 0% to 0.8% of patients in large-scale randomized trials of ranibizumab and aflibercept for macular edema in RVO. 5,7,[14][15][16] Rhegmatogenous retinal detachment developed in 1 eye (0.0026%) after 38,503 intravitreal ranibizumab injections were carried out in 1 Danish center and in 5 eyes (0.013%) after 35,942 anti-VEGF injections were carried out in several German centers.…”

Section: Ranibizumabmentioning

confidence: 99%

A Review of Randomized Trials of Approved Pharmaceutical Agents for Macular Edema Secondary to Retinal Vein Occlusion

Wang

2016

Asia-Pacific Journal of Ophthalmology

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There are 3 approved pharmaceutical agents for treating macular edema secondary to retinal vein occlusion (RVO): dexamethasone (a corticosteroid) implant and ranibizumab and aflibercept (both antivascular endothelial growth factor agents). All show a superior ability to improve vision and reduce macular thickness in comparison with sham injections or macular grid laser treatment. Prompt treatment with these agents may lead to a better outcome. A review of randomized trials of injected aflibercept or ranibizumab reveals protocol variations. They include "as needed" injections until functional and anatomical changes are achieved, preceded by either 1 injection or 3 to 6 monthly injections as loading doses. Ocular and systemic adverse effects of vascular endothelial growth factor antagonists for macular edema secondary to RVO are rarely severe. The antiedematous response to a single intravitreal dexamethasone implant is maximal 1 to 3 months after the injection. Intraocular pressure elevation and cataract aggravation should be monitored after the use of intravitreal dexamethasone implants. Intravitreal dexamethasone implants and ranibizumab injections reduce not only macular edema, but also the risk of retinal ischemia and neovascularization in patients with RVO.

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Current Infectious Endophthalmitis Rates After Intravitreal Injections of Anti-Vascular Endothelial Growth Factor Agents and Outcomes of Treatment

Abstract: Endophthalmitis after anti-VEGF injection was uncommon in our institution and in the population-based database. Treatment outcomes were variable but generally fared better in the culture-negative cases.

Cited by 61 publications

References 16 publications

Pars Plana Vitrectomy for Late Vitreoretinal Sequelae of Infectious Endophthalmitis

Pars Plana Vitrectomy for Late Vitreoretinal Sequelae of Infectious Endophthalmitis

Rates of Reoperation and Retinal Detachment after Macular Hole Surgery

A Review of Randomized Trials of Approved Pharmaceutical Agents for Macular Edema Secondary to Retinal Vein Occlusion

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