Global reported endophthalmitis risk following intravitreal injections of anti-VEGF: a literature review and analysis

Sigford, Douglas Kenneth; Reddy, Shivani V.; Mollineaux, Christine; Schaal, Shlomit

doi:10.2147/opth.s77067

Cited by 33 publications

(33 citation statements)

References 28 publications

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“…Antibiotic treatment protocols differed between selected studies and insufficient data precluded further analyses on protocols used. The incidence of culture-negative endophthalmitis may seem high however, it is similar to literature (0.022%) [ 5 ]. Even if non-significant, the culture-proven endophthalimitis odds ratio of 0.552 (CI 95% 0.240–1.265, p = 0.160) for the antibiotics group compared with the group without antibiotics may limit generalizability.…”

Section: Discussionsupporting

confidence: 83%

“…Transfixing perforation of the sclera of the eye by the injection needle might lead to infectious complications, specifically endophthalmitis [ 3 ]. Although rare [ 4 , 5 , 6 , 7 ], endophthalmitis is the most feared complication of intravitreal injections due to its poor functional prognosis [ 8 ]. Strategies for infection prophylaxis are generally based on the use of antiseptics and antibiotics.…”

Section: Introductionmentioning

confidence: 99%

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Antibioprophylaxis in Prevention of Endophthalmitis in Intravitreal Injection: A Systematic Review and Meta-Analysis

et al. 2016

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Despite endophthalmitis being the most feared complication, antibioprophylaxis remains controversial in intravitreal injections. Therefore, we conducted a systematic review and meta-analysis on the effects of antibioprophylaxis in intravitreal injections in the prevention of endophthalmitis. The PubMed, Cochrane Library, Embase and Science Direct databases were searched for studies comparing groups with and without antibiotics in intravitreal injection, with the use of the following keywords: "antibiotic*", "endophthalmitis" and “intravitreal injection*”. To be included, studies needed to specify number of participants and number of endophthalmitis within each group (with and without antibiotics). We conducted meta-analysis on the prevalence of clinical endophthalmitis including both culture-proven and culture negative samples. Nine studies were included. A total of 88 incidences of endophthalmitis were reported from 174,159 injections (0.051% i.e., one incidence of endophthalmitis for 1979 injections). Specifically, 59 incidences of endophthalmitis were reported from 113,530 injections in the group with antibiotics (0.052% or one incidence of endophthalmitis for 1924 injections) and 29 incidences of endophthalmitis from 60,633 injections in the group without antibiotics (0.048% or one endophthalmitis for 2091 injections). Our meta-analysis did not report a significant difference in the prevalence of clinical endophthalimitis between the two groups with and without topical antibiotics: the odds ratio of clinical endophthalimitis was 0.804 (CI95% 0.384–1.682, p = 0.56) for the antibiotic group compared with the group without antibiotics. In conclusion, we performed the first large meta-analysis demonstrating that antibioprophylaxis is not required in intravitreal injections. Strict rules of asepsis remain the only evidence-based prophylaxis of endophthalmitis. The results support initiatives to reduce the global threat of resistance to antibiotics.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Antibioprophylaxis in Prevention of Endophthalmitis in Intravitreal Injection: A Systematic Review and Meta-Analysis

et al. 2016

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“…This has also been confirmed by a literature review summarizing data of 445,503 IVI, which did not show a significant difference between OR [71, 72, 78, 79] and office-based IVI [67-70]. …”

Section: Peri- /Injection Management In Intravitreal Pharmacotherapymentioning

confidence: 54%

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

et al. 2018

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Intravitreal injections (IVI) have become the most common intraocular procedure worldwide with increasing numbers every year. The article presents the most up-to-date review on IVI epidemiology and techniques. Unfortunately, important issues related to pre-, peri- and postinjection management lack randomized clinical trials for a final conclusion. Also, a great diversity of approaches exists worldwide. Therefore, expert consensus recommendations on IVI techniques are provided.

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“…[ 17 ] [ 20 ] In addition, the frequency of very rare procedure-related events, such as endophthalmitis, is better studied in large observational series or registries rather that in RCTs. [ 21 ]…”

Section: Discussionmentioning

confidence: 99%

Treatment as Required versus Regular Monthly Treatment in the Management of Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis

et al. 2015

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BackgroundTo investigate whether treatment as required ‘pro re nata’ (PRN) versus regular monthly treatment regimens lead to differences in outcomes in neovascular age-related macular degeneration (nAMD). Regular monthly administration of vascular endothelial growth factor (VEGF) inhibitors is an established gold standard treatment, but this approach is costly. Replacement of monthly by PRN treatment can only be justified if there is no difference in patient relevant outcomes.MethodsSystematic review and meta-analysis. The intervention was PRN treatment and the comparator was monthly treatment with VEGF-inhibitors. Four bibliographic databases were searched for randomised controlled trials comparing both treatment regimens directly (head-to-head studies). The last literature search was conducted in December 2014. Risk of bias assessment was performed after the Cochrane Handbook for Systematic Reviews of Interventions.FindingsWe included 3 head-to-head studies (6 reports) involving more than 2000 patients. After 2 years, the weighted mean difference in best corrected visual acuity (BCVA) was 1.9 (95% CI 0.5 to 3.3) ETDRS letters in favour of monthly treatment. Systemic adverse events were higher in PRN treated patients, but these differences were not statistically significant. After 2 years, the total number of intravitreal injections required by the patients in the PRN arms were 8.4 (95% CI 7.9 to 8.9) fewer than those having monthly treatment. The studies were considered to have a moderate risk of bias.ConclusionsPRN treatment resulted in minor but statistically significant decrease in mean BCVA which may not be clinically meaningful. There is a small increase in risk of systemic adverse events for PRN treated patients. Overall, the results indicate that an individualized treatment approach with anti-VEGF using visual acuity and OCT-guided re-treatment criteria may be appropriate for most patients with nAMD.

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Global reported endophthalmitis risk following intravitreal injections of anti-VEGF: a literature review and analysis

Cited by 33 publications

References 28 publications

Antibioprophylaxis in Prevention of Endophthalmitis in Intravitreal Injection: A Systematic Review and Meta-Analysis

Antibioprophylaxis in Prevention of Endophthalmitis in Intravitreal Injection: A Systematic Review and Meta-Analysis

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

Treatment as Required versus Regular Monthly Treatment in the Management of Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis

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