June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Meta-Analysis of Infectious Endophthalmitis After Intravitreal Injection of Anti-Vascular Endothelial Growth Factor Agents
Author Affiliations & Notes
  • John Fileta
    Department of Ophthalmology, Penn State College of Medicine, Hershey, PA
  • Ingrid Scott
    Department of Ophthalmology, Penn State College of Medicine, Hershey, PA
    Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
  • Harry Flynn
    Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL
  • Footnotes
    Commercial Relationships John Fileta, None; Ingrid Scott, None; Harry Flynn, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 1118. doi:
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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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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: 513 endophthalmitis • 688 retina • 561 injection  
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