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Colin McCannel, Travis Meredith, Ellen Peskin, Maureen Maguire, Charles Barr, Beranrd Doft, Jonathan Prenner, ; Incidence of Endophthalmitis after Anti-VEGF Injections and use of Anti-Microbials in the Comparison of AMD Treatments Trials (CATT). Invest. Ophthalmol. Vis. Sci. 2013;54(15):1114.
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To describe incident cases of endophthalmitis and ascertain whether perioperative topical antimicrobials exerted a protective effect after intraocular injections of anti-VEGF agents in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT) and the impact of endophthalmitis on visual acuity (VA).
Through 2 years, patients enrolled in CATT (N=1185) were evaluated every 28 days and treated with intravitreal injection of ranibizumab or bevacizumab according to the assigned dosing regimen (monthly or PRN). Study ophthalmologists examined patients who reported symptoms and initiated treatment immediately upon diagnosis of endophthalmitis. Change in VA from the time of the last treatment injection preceding the onset of endophthalmitis symptoms to the last study visit was calculated for eyes that developed endophthalmitis. Administration and timing of topical prophylactic antimicrobials was at the discretion of the study ophthalmologist. Injections were classified into four groups based on use and timing of topical ocular antimicrobial administration: 1) pre-injection only (n=1301); 2) post-injection only (n=5247): 3) both pre and post injection (n=9961); 4) no antibiotic (n=2000). Comparisons were made for rates of endophthalmitis between groups.
Eleven cases of post-injection endophthalmitis occurred among 18,509 injections (0.06%: [95% CI: 0.03%-0.11%]). Of the 10 eyes with follow-up visual acuity, 5 (50%) eyes returned to VA within 10 letters (range +8 to -9) of their VA prior to injection, and 5 eyes (50%) lost 15 or more letters (range -17 to -63). Event rates for the four antimicrobial treatment groups were: 1) pre injection-only: 1 case (0.08%); 2) post injection-only: 3 cases (0.06%); both pre and post injection: 4 cases (0.04%); and 4) no antibiotic: 3 cases (0.15%). Differences in the incidence of endophthalmitis among the groups were not statistically significant (p=0.20).
Endophthalmitis rates in CATT were low and consistent with the results of other large clinical trials of intraocular injections of anti-VEGF agents and triamcinolone. Infections occurred despite topical ocular antimicrobial administration, and risk did not depend on whether or not antimicrobials were used, or on the timing of antimicrobial dosing.
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