Incidence of endophthalmitis following intravitreal anti VEGF injections at a tertiary care hospital in Pakistan

Abstract

Objective: It is to report the rate of infectious endophthalmitis (IE) with Anti VEGF injection in our set up and compare our procedure protocols with those being practiced on international and local level. Methods: A single hospital based retrospective, consecutive case series conducted at Shifa International Hospital, Islamabad after taking International Review Board (IRB) approval from the hospital’s ethics review committee. Total 7542 Anti-VEGF injections; 5976 (79.2%) Bevacizumab (Avastin), 1081 (14.3%) Ranibizumab (Patizra/ Lucentis) and 485 (6.4%) Aflibercept (Eylea) were administered to 2734 patients in a clean room in an office based setup during the 5 years i.e. August 2014 to July 2019. Results: Only a single case of IE occurred during the study period that led to IE rate of 0.01% (1 out of 7542 injections) compared to the 0.028% previously reported in international literature and 0.027% in a local study. IE was successfully treated with 25 gauge pars plana vitrectomy. Conclusion: Our results depict that Anti VEGF injections can be administered in a clean room as a routine procedure in an office based setup by following standard sterilization protocols. Also, we strongly discourage the practice of giving same day bilateral IVT injections as this put the patients at the risk of bilateral IE leading to grave consequences. Timely diagnosis and intervention are pivotal in the management of this devastating complication. Keywords: Bevacizumab, Endophthalmitis, Intravitreal injections, Continuous...

Endophthalmitis After Intravitreal Bevacizumab (Avastin) Injections: An Outbreak Investigated

“…The most important complication occurring after IVT injections is postinjection endophthalmitis. Endophthalmitis following bevacizumab injections (in-house compounded) had an incidence of 0.0377% in one cohort in Pakistan [1]. The patient developed pain, redness, and in most cases marked deterioration of vision (while pre-injection vision in many cases is not bad).…”