September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Comparison of post-injection endophthalmitis rates and characteristics following intravitreal injections of bevacizumab versus ranibizumab versus aflibercept
Author Affiliations & Notes
  • Jason Hsu
    Wills Eye Hospital, Philadelphia, Pennsylvania, United States
    Mid Atlantic Retina, Plymouth Meeting, Pennsylvania, United States
  • Nadim Rayess
    Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Ehsan Rahimy
    Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Chirag Shah
    Ophthalmic Consultants of Boston, Boston, Massachusetts, United States
  • Jeremy D Wolfe
    Associated Retinal Consultants at William Beaumont Hospital, Royal Oak, Michigan, United States
  • Eric Chen
    Retinal Consultants of Houston, Houston, Texas, United States
  • Francis Char DeCroos
    Southeastern Retina Associates, Chattanooga, Tennessee, United States
  • Sunir Garg
    Wills Eye Hospital, Philadelphia, Pennsylvania, United States
    Mid Atlantic Retina, Plymouth Meeting, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Jason Hsu, Genentech (F), Ophthotech (F), Ophthotech (C); Nadim Rayess, None; Ehsan Rahimy, None; Chirag Shah, None; Jeremy Wolfe, Alimera (R), Allergan (F), Allergan (R), Genentech (F), Genentech (R); Eric Chen, None; Francis DeCroos, None; Sunir Garg, None
  • Footnotes
    Support  J. Arch McNamara, MD Memorial Fund for Retina Research and Education (Wills Eye Hospital)
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 6370. doi:
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      Jason Hsu, Nadim Rayess, Ehsan Rahimy, Chirag Shah, Jeremy D Wolfe, Eric Chen, Francis Char DeCroos, Sunir Garg; Comparison of post-injection endophthalmitis rates and characteristics following intravitreal injections of bevacizumab versus ranibizumab versus aflibercept. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6370.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Endophthalmitis outbreaks due to bacterial contamination of compounded drugs have been rarely reported but have led to a perceived increased risk of endophthalmitis with compounded bevacizumab. This study compared the incidence and clinical outcomes of endophthalmitis following intravitreal injections of compounded bevacizumab versus ranibizumab and aflibercept from single-use vials.

Methods : This was a multicenter, retrospective consecutive case series, which included patients with neovascular age-related macular degeneration, diabetic eye disease or retinal vein occlusion who received intravitreal injections of compounded bevacizumab, ranibizumab or aflibercept between January 1, 2009 and September 30, 2013 at 5 retina practices. Billing records were used to ascertain the total number of anti-vascular endothelial growth factors (VEGF) injections administered during the time frame. Patients with endophthalmitis were identified from endophthalmitis logs and billing records. Chart review was then performed to confirm that the endophthalmitis was related to the antecedent anti-VEGF injection. Visual outcomes, causative organisms and clinical course were also recorded.

Results : A total of 503,890 anti-VEGF injections were included, from which 183 cases of presumed endophthalmitis were identified (0.036%). The rate of endophthalmitis for bevacizumab was 60/153,812 (0.039%), which was similar to ranibizumab 109/309,722 (0.035%; P=0.522) and aflibercept 14/40,356 (0.035%; P=0.693). There was also no difference in the rates between ranibizumab and aflibercept (P=0.960). The culture positive rate of the vitreous/aqueous tap was 38% for bevacizumab as well as ranibizumab and 43% for aflibercept. The most common organism was Staphylococcus epidermidis for bevacizumab and coagulase-negative Staphylococcus for ranibizumab. All 6 cases of endophthalmitis after aflibercept were due to 6 different organisms.

Conclusions : Endophthalmitis after intravitreal injections of compounded bevacizumab versus ranibizumab and aflibercept from single-use vials appears to occur at similar rates and have comparable visual outcomes. This study suggests that the concern for an increased risk of endophthalmitis due to compounded bevacizumab is likely unfounded. As a result, the choice of anti-VEGF agent should be based on other factors, such as efficacy and cost.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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