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Ulrich Kellner, Ruth Kölb-Keerl, Detlef Engineer, Andreas Kersten, Norbert Körber, VOA Study Group; Risk Of Endophthalmitis In A Large Series (135.729 injections) Of Patients Treated With Intravitreal Anti-VEGF or Dexamethasone Injections. Invest. Ophthalmol. Vis. Sci. 2014;55(13):585.
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To evaluate the risk of endophthalmitis associated with intravitreal injections in patients with neovascular age-related macular degeneration, diabetic macular edema, macular edema associated with retinal vein occlusion, myopic choroidal neovascularization or macular edema in uveitis.
Intravitreal injections were performed according to certified protocols in 35 outpatient clinics in the area of Nordrhein in Western Germany. Quality control included established protocols and external review of hygienic conditions for the surgical procedure, requirements on the experience of surgeons (at least 500 intraocular surgeries with at least 200 in the last 2 years) as well as a quality control of randomly selected cases regarding indication and timing of treatment. During the period, indications for treatment and drug selection developed in accordance with regularly updated guidelines recommended by the national faculty for treatment of macular disease in Germany. Intravitreal injections performed between January 2008 and November 2013 were included in this retrospective evaluation.
Over the period of nearly 6 years the outcome of 135.729 intravitreal injections could be evaluated. During this time, 14 patients developed an endophthalmitis (0,010%) and underwent vitrectomy and intravitreal antibiotic therapy. All 14 patients were treated with anti-VEGF medication (Bevacizumab, Ranibizumab or Aflibercept).
Intravitreal treatment of macula diseases is a safe procedure in outpatient clinics if performed in accordance with established safety protocols. Continuous supervision of adherence to agreed standards of procedure within the group of ophthalmic surgeons appears to be an effective means for patient safety.
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