Incidence of Acute Onset Endophthalmitis Following Intravitreal Bevacizumab (Avastin) Injection

Abstract

A retrospective review of 5,233 consecutive intravitreal injections of bevacizumab (Avastin) revealed only a single case of acute endophthalmitis. Adherence to aseptic technique and the use of povidone-iodine prophylaxis minimizes the risk of postinjection intraocular infection.

Incidence and management of acute endophthalmitis after intravitreal bevacizumab (Avastin) injection

“…18 In this study, pre-injection antibiotics and eyelid speculum were not used within the procedure. Mason et al 19 reported only one case among 5233 consecutive IVB injections. In that study, the decision whether to use pre-injection and/or post-injection antibiotics, as well as whether to place a lid speculum, was made at the discretion of each treating physician.…”

“…Numerous studies indicate that the most common source of bacteria appears to be from the patients' own flora. [18][19][20][21] Blepharitis is a reported risk factor for endophthalmitis, [19][20][21][22] and the risk may be increased during an office-based procedure where the sterile technique may not be as rigorous as in the operating room setting. Despite disinfection of the lids and conjunctival surface with povidone-iodine, the lashes may serve as a nidus of infection if they abut the needle before its entry into the eye.…”

Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature

“…10,11 However, the reported rate in the recent studies tends to be lower than that in early trials. [10][11][12][13][14][15][16] The rate of endophthalmitis seems to be the same among different anti-VEGF agents, 12 different injection settings, 15 and different geographical locations. 17 Recent studies reported that endophthalmitis caused by Streptococcus species was significantly more frequent after intravitreal injection than after intraocular surgery.…”

Post-intravitreal anti-VEGF endophthalmitis in the United Kingdom: incidence, features, risk factors, and outcomes

“…16,17,22,41 More recently, larger studies have been published reporting risk factors for PIAE. Shah et al 42 reported a case control study of 23 cases of PIAE that did not find any of the variables they studied to be significant risk factors.…”