Incidence of endophthalmitis after intravitreal injection of an anti-VEGF agent with or without topical antibiotics

Abstract

Intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) is the standard treatment modality in various types of retinal diseases. However, endophthalmitis remains the most serious complication. Despite the lack of evidence that antibiotics prevent endophthalmitis, topical antibiotics are still used routinely in Japan. We conducted a retrospective multicenter study by analyzing records from patients who underwent IVI of anti-VEGF agents with or without antibiotic treatment. In the analysis of a total of 147,440 eyes, the incidence of endophthalmitis was 0.007%: 0.005% with no use of antibiotics, 0.009% with antibiotic pretreatment, 0.012% with posttreatment, and 0.005% with pre- and posttreatment. There was no statistically significant difference among the four groups (chi-square test, p = 0.57). Most facilities used masks, sterilized gloves, and drapes. Nine of the 10 eyes that developed endophthalmitis received topical antibiotics, and all infected eyes underwent IVI with aflibercept, not the prefilled syringe delivery system. In four patients who received multiple IVI, the detection of causative bacteria revealed resistance to used antibiotics. Data from this large population, treated with or without antibiotics, suggests that antibiotic prophylaxis does not reduce the rate of endophthalmitis after IVI.

Safety Measures for Maintaining Low Endophthalmitis Rate after Intravitreal Anti-Vascular Endothelial Growth Factor Injection before and during the COVID-19 Pandemic

“…The endophthalmitis rates differ depending on the underlying diseases. Topical administration of antibiotics before and after intravitreal injection is not practiced in many countries, because this practice does not reduce the incidence of endophthalmitis, and also increases antibiotic resistance [6][7][8][9].…”

Protective Effect of Total Panax Notoginseng Saponins on Retinal Ganglion Cells of an Optic Nerve Crush Injury Rat Model

“…At present, the injection of antibiotics into the vitreous cavity is still controversial and may even increase the risk of infection so we still exert the prevention of systemic and local antibiotics. Strict and precise control of aseptic operation is the most important preventive measure [ 50 , 51 ]. On this regard, it could be useful to develop in the near future a biodegradable deliver system to inject intravitreally the TPNS, avoiding a multiple treatment [ 52 ].…”

Reduced Incidence of Intravitreal Injection–Related Endophthalmitis With Prefilled Syringes

“…2–6 Infectious organisms can be introduced into the eye after operative and office-based procedures such as cataract surgery and intravitreal injections. 7–15…”

“…20 As a result, many studies have analyzed the injection procedure to identify practice patterns that could potentially increase the risk for infection. 8,9,13,21 In particular, some have suggested that potential contamination might occur when medications are manually transferred from a packaged vial into a separate injection syringe. 22…”