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John Fileta, Ingrid Scott, Harry Flynn; Meta-Analysis of Infectious Endophthalmitis After Intravitreal Injection of Anti-Vascular Endothelial Growth Factor Agents. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1118.
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To investigate the rate of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents, the spectrum of causative organisms, and associated visual outcomes.
A literature search was performed of the National Library of Medicine PubMed interface using keywords ‘‘endophthalmitis’’ and ‘‘intravitreal’’ between 01/01/2005 through 05/09/2012 (search date: 05/09/2012). Articles were reviewed and additional studies pertinent to endophthalmitis following intravitreal anti-VEGF injection were identified. Inclusion criteria included article in English, >100 intravitreal anti-VEGF injections, and report of adverse events including endophthalmitis. Endophthalmitis rates, causative organisms, and visual acuity outcomes were analyzed.
Forty-three articles were analyzed. Endophthalmitis occurred following 197/350,535 (0.056% [95% confidence interval [CI], 0.049-0.065%]) intravitreal anti-VEGF injections. The most common organisms isolated were coagulase-negative staphylococcus (26/68; 38.24% [95% CI, 27.6-50.2%]) and Streptococcus species (20/68; 29.41% [95% CI, 20.0-41.2%]). A final vision within one line of the pre-injection Snellen acuity was achieved by 23.53% of patients with endophthalmitis caused by Streptococcus species, 43.75% of patients with endophthalmitis caused by coagulase-negative staphylococcus, and 64.71% of patients with culture-negative endophthalmitis; 94.12%, 12.50%, and 31.37% of patients, respectively, had a final acuity of 20/400 or worse.
The reported rate of endophthalmitis following intravitreal anti-VEGF injection is low. Coagulase-negative staphylococcus and Streptococcus species were the most common causative organisms. Streptococcus species is the causative organism of endophthalmitis more frequently following intravitreal anti-VEGF injection than reported following most incisional intraocular surgeries. Among patients with endophthalmitis following intravitreal anti-VEGF injection, endophthalmitis caused by streptococcus is associated with poorer visual outcomes than endophthalmitis caused by coagulase-negative staphylococcus and culture-negative cases.
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