Endophthalmitis following Intravitreal Anti-Vascular Endothelial Growth Factor Therapy: Changes in Incidence and Outcomes over a 9-Year Period

ABSTRACT

Aims: To evaluate whether the incidence, microbial spectrum, and visual outcomes of endophthalmitis following intravitreal injections have changed over time.

Methods: Retrospective cohort study of endophthalmitis in eyes receiving intravitreal injection of anti-vascular endothelial growth factor between 2009–2012 and 2016–2017 at a single, large retina practice.

Results: A total of 283,315 injections resulted in 96 suspected infectious endophthalmitis cases. Comparing 2009–2012 and 2016–2017, the rate of suspected endophthalmitis changed from 1 in 2,663 injections to 1 in 3,195 injections (p = .37). Visual outcomes 6 months after endophthalmitis were significantly better during the latter period (p = .04), with an average loss of 6.3 lines of VA in 2009–2012 compared to a loss of 3.6 lines in 2016–2017. In multivariate analysis, a “no-talking” policy during injections resulted in a trend towards a decrease in endophthalmitis incidence (p = .08). Cessation of post-injection topical antibiotic use did not independently decrease endophthalmitis incidence (p = .24) when the effect of a “no-talking” policy was taken into account. A lower rate of endophthalmitis was seen after prefilled vs. conventionally prepared ranibizumab syringe use for injection (0.014% vs. 0.035%, respectively), though this difference did not meet statistical significance (p = .16).

Conclusion: The incidence of endophthalmitis after intravitreal injection decreased and visual outcomes improved between the periods of 2009–2012 and 2016–2017. A “no-talking” policy during injections was associated with a trend toward a decrease in endophthalmitis rate.

KEYWORDS:

• Aflibercept
• anti-VEGF
• bevacizumab
• endophthalmitis
• ranibizumab

Data Availability Statement

Data analyzed in this study consist of deidentified participant data that underlie the results reported in this study. It is available upon reasonable request to researchers who provide a methodologically sound proposal to achieve the aims in the approved proposal. Proposals may be submitted to [email protected].

Declaration of Interest Statement

All authors declare no support from any organization for the submitted work. Dr. Garg reports personal fees from Deciphera, personal fees from Bausch & Lomb, personal fees from Johnson & Johnson, personal fees from Topivert, personal fees from Allergan, grants from Genentech, grants from Regeneron, grants from Aerpio, grants from Wills Eye Hospital Retina Implant, grants from Apellis, grants from Boehringer Ingelheim, grants from Eyegate, outside the submitted work. Dr. Klufas reports personal fees from Genentech, personal fees from Allergan, personal fees from Regeneron, outside the submitted work. Dr. Hsu reports grants from Genentech, grants from Ophthotech, grants from Santen, outside the submitted work. No other relationships or activities exist that could appear to have influenced the submitted work.

Additional information

Funding

The authors have received no financial support for this study.