July 02, 2018
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Low endophthalmitis rate found after intravitreal injections

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Analysis of 12 years of data on intravitreal injections in a large tertiary referral center showed a low rate of endophthalmitis as a complication. No difference was found among anti-VEGF agents, and the least favorable visual acuity results were related to Streptococcus infection.

The authors performed a retrospective review of the clinical and microbiology records of all patients who presented to Bascom Palmer Eye Institute between January 2005 and December 2017 with a diagnosis of endophthalmitis after intravitreal anti-VEGF injections. This population included patients who had been treated on site as well as patients referred from outside practices.

At Bascom Palmer, a strict antisepsis protocol was followed, and starting from 2008, the use of topical antibiotics was gradually phased out.

In total, 39 eyes were culture-positive for endophthalmitis, 12 of which were injected at Bascom Palmer and 27 at outside practices. Nine of the outside cases were associated with an outbreak of Streptococcus endophthalmitis from contaminated pharmacy-compounded bevacizumab.

The authors noted that the overall rate of endophthalmitis at Bascom Palmer was low and decreased from 0.019% to 0.009% after complete cessation of topical antibiotic prophylaxis. The overall rate over the past decade was 0.013%, approximately one in 7,000, and did not differ among anti-VEGF agents.

The most common isolates were Staphylococcus and Streptococcus species. Intravitreal vancomycin and ceftazidime (amikacin in one case) were used for the initial treatment.

Visual acuity results were variable, with 54% of eyes achieving 5/200 or better. Outcomes were worse with Streptococcus infection, possibly due to the earlier onset of more virulent organisms in cases presenting within 3 days after injection.

“The current study corroborates previous reports that establish a consistently low rate of infection after intravitreal injection,” the authors wrote. “Furthermore, prophylactic antibiotics do not appear necessary to maintain a low incidence of infection. Indeed, current evidence suggests that the rate of endophthalmitis with antibiotic prophylaxis may even be higher.”– by Michela Cimberle

Disclosures: Yannuzzi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.