VIENNA — A study conducted on a large database showed that the rate of endophthalmitis following intravitreal injections is low and does not increase with successive injections. A higher rate of noninfectious endophthalmitis was found with bevacizumab compared with other agents.
“Endophthalmitis is one of the most feared complications of intraocular procedures and anti-VEGF injections are no exception,” Daniel Barthelmes, MD, PhD, said at the Euretina meeting. “The increasing number of patients with neovascular AMD and the associated number of injections they need have put endophthalmitis in the spotlight.”
This prospectively designed study included eyes with neovascular AMD tracked by the Fight Retinal Blindness (FRB) registry that commenced anti-VEGF therapy between 2006 and 2016.
Infectious endophthalmitis occurred in 18 of 88,150 injections, which equates to approximately 1 in 5,000 injections. No significant difference was found between types of anti-VEGF medications.
Noninfectious endophthalmitis was identified in 11 of 88,150 injections, which equates to 1 approximately in 8,000 injections. Over approximately 6 years, only a very slight increase of incidence was observed.
“Interestingly, incidence was higher in this group when using bevacizumab (8/9,931) as compared to ranibizumab (3/54,776) or aflibercept (0/23,425). Over 6 years we can see a slight increase in the beginning and then a plateau,” Barthelmes said.
A loss of more than 2 lines of vision at 1 year was observed in about one-third of infectious cases vs. one-fourth of noninfectious cases.
“A slow recovery of vision occurs over time but, eventually, the vision the patients had before endophthalmitis is not reached again and regresses to the vision they had before commencing the anti-VEGF treatment,” Barthelmes said. – by Michela Cimberle
Barthelmes D, et al. Incidence and outcomes of infectious and noninfectious endophthalmitis after intravitreal injections for age-related macular degeneration. Presented at: Euretina; Sept. 20-23, 2018; Vienna.
Disclosure: Barthelmes reports no relevant financial disclosures.
Editor's note: This article was updated to correct the quoted incidence of endophthalmitis rates.