Endophthalmitis after intravitreal anti-vascular endothelial growth factor antagonists: a six-year experience at a university referral center"

Abstract

Purpose:: To assess the rate of as well as to describe the clinical and microbiological features of eyes that develop clinically suspected endophthalmitis following an intravitreal injection of vascular endothelial growth factor (VEGF) antagonists.

Methods:: The records of patients undergoing intravitreal injections of anti-VEGF agents from 01/01/2005 through 12/31/2010 at a single University referral center and associated satellite clinics were retrospectively analyzed to determine the rate of infectious endophthalmitis following intravitreal anti-VEGF injections.

Results:: Twelve cases (eleven patients) of clinically suspected endophthalmitis were identified out of a total of 60,322 injections (0.02%, 95% confidence interval 0.0114% to 0.0348%). Eleven of the twelve cases presented within 3 days of the injection. Of the 7 culture-positive cases, 5 were due to Streptococcus species. In 4 of the 5 Streptococcus cases, final visual acuity was hand motions or worse. The rate of clinically suspected endophthalmitis was 0.018% after bevacizumab and 0.027% after ranibizumab.

Conclusions:: A very low rate of endophthalmitis after intravitreal injections of anti-VEGF agents. Patients typically presented within three days of injection. Streptococcus species was the most common bacteria isolated and it was generally associated with poor visual outcomes.

Figure 1:

Line graph depicting the annual numbers of intravitreal ranibizumab, bevacizumab, and pegaptanib injections performed at our institution between 2005 and 2011.