Evaluation of the Incidence of Endophthalmitis after Intravitreal Injection of Anti-Vascular Endothelial Growth Factor

Abstract

Aims: To report the incidence of infectious and noninfectious endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor (VEGF) from a multicenter clinical trial in Japan. Methods: A retrospective multicenter review of the data of patients who received intravitreal anti-VEGF injections between January 2007 and March 2011 was undertaken. Cases with the clinical diagnosis of endophthalmitis resulting from intravitreal injection were identified and reviewed. Results: A total of 5,236 intravitreal anti-VEGF injections (1,209 intravitreal injections of bevacizumab, 3,827 injections of ranibizumab, and 200 injections of pegaptanib sodium) had been administered. Five patients (0.095%), all of whom had received bevacizumab, were diagnosed as having endophthalmitis after the intravitreal injection. All patients visited the institutes for re-examination within 1–2 days after the injection. Among the 5 patients, 2 (0.038%) were culture positive for Streptococcus oralis and Enterococcus faecalis, respectively. The remaining 3 eyes (0.057%) developed presumed noninfectious endophthalmitis. Conclusion: Although endophthalmitis is a rare complication associated with intravitreal injection, in this series intravitreal anti-VEGF injection caused infectious or noninfectious endophthalmitis at a relatively high frequency. Further investigations are needed to consider an appropriate injection protocol for minimizing the incidence rates of endophthalmitis, and to assess the optimal treatment protocol for intravitreal injection-related endophthalmitis although it was difficult to differentiate these two entities.

Long-term outcome of intravitreal ranibizumab treatment, compared with photodynamic therapy, in patients with polypoidal choroidal vasculopathy

“…Furthermore, we reported that bevacizumab injection was significantly higher to cause endophthalmitis compared with ranibizumab. 25 To realize an appropriate costeffectiveness treatment for AMD is needed in the future.…”

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 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.…”

Endophthalmitis als schwere Komplikation der intravitrealen Medikamentengabe

“…In einer retrospektiven 6-Jahres-Analyse berichtet Moshfeghi et al von 12 Patienten mit einer Endophthalmitis von 60 322 behandelten Augen, was einer Inzidenz von 0,02 % entspricht [17]. Eine irische Studie berichtet von einer Inzidenz von 0,1 % bei 5900 Injektionen und eine japanische Arbeit berichtet von einer Inzidenz von 0,095 % bei 5236 behandelten Augen [18,19].…”