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Andrew A. Moshfeghi, Philip J. Rosenfeld, Harry W. Flynn, Jr., Stephen G. Schwartz, Janet L. Davis, Timothy G. Murray, William E. Smiddy, Audina M. Berrocal, Thomas A. Albini; Endophthalmitis After Intravitreal Vascular Endothelial Growth Factor Antagonists: A Seven-year Experience At A University Referral Center.endophthalmitis After Intravitreal Vascular Endothelial Growth Factor Antagonists: A Seven-year Experience At A University Referral Center. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1693.
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To assess the rate of infectious endophthalmitis and to describe the clinical and microbiological features of eyes that develop clinically suspected endophthalmitis after an intravitreal injection of vascular endothelial growth factor (VEGF) antagonists.
The medical records of patients undergoing intravitreal injections of anti-vascular endothelial growth factor agents from January 1, 2005, through November 30, 2011, at a single university referral center and associated satellite clinics were retrospectively analyzed to determine the rate of infectious endophthalmitis after intravitreal anti-vascular endothelial growth factor injections.
Twelve cases (11 patients) of clinically suspected endophthalmitis were identified after a total of 75,018 injections (0.016%, 95% confidence interval, 0.0092% to 0.0280%). Of the 12 cases, 11 presented within 3 days of the injection. Of the 7 culture-positive cases (0.009% rate of culture positive endophthalmitis; 95% confidence interval, 0.0045% to 0.0193%), 5 were because of Streptococcus species. In 4 of the 5 Streptococcus cases, final visual acuity was hand motions or worse. There was no statistically significant difference noted in the rates of infection encountered following different types of anti-VEGF injections (pegaptanib, ranibizumab, bevacizumab, or aflibercept). All cases of endophthalmitis occurred with patients who were receiving post-injection antibiotics. In the last three years, the majority of physicians have not used antibiotics after intravitreal injections and no cases of endophthalmitis have been encountered in this cohort.
A very low rate of endophthalmitis after intravitreal injections of anti-vascular endothelial growth factor agents was observed. Patients typically presented within 3 days of injection. Streptococcus species was the most common bacteria isolated, and it was generally associated with poor visual outcomes. The use of topical antibiotics does not appear to mitigate the risk of endophthalmitis after intravitreal injections.
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