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Harry W Flynn, Ninel Gregori, Andrew A Moshfeghi, Philip J Rosenfeld, Stephen G Schwartz, Jorge Fortun, Jaclyn L Kovach, Kamyar Vaziri, Thomas Arno Albini; Current Endophthalmitis Incidence Rates After Intravitreal Anti-VEGF Injections and Outcomes of Treatment. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4193.
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To assess the incidence rates and outcomes of infectious endophthalmitis after intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents.
Records of patients undergoing intravitreal cultures and antibiotics after anti-VEGF injections from January 1, 2005 through December 31, 2013, at the Bascom Palmer Eye Institute (BPEI) were reviewed. In addition, the 2011 data from the largest commercial Claims and Encounters database in the U.S. (the MarketScan) was utilized to calculate the population-based endophthalmitis incidence rate.
The population-based incidence rate of endophthalmitis after anti-VEGF injections was 22/79,998 (0.027%) in 2011. The BPEI incidence rate was 20/104,561 injections (0.019%) administered during study period. In the BPEI cases for each anti-VEGF medication, the rates were the following: Bevacizumab 8/61262 (0.013%), Ranibizumab 6/30367 (0.020%), Aflibercept 6/11208 (0.050%) and Pegaptanib 0/2005 (0%). Diagnosis was made within 3 days of the injection in 19 cases but 1 culture negative case occurred at 15 days. Nine BPEI cases were culture-positive: Streptococcus species (5), coagulase-negative Staphylococcus (3), and Bacillus non-anthracis (1). Final VA varied from 20/25 to NLP. Of the 9 culture positive cases, 4 achieved 20/100 or better but 4 remained light perception or worse. Of the 11 culture negative cases, 9 improved to 20/100 or better (baseline visual acuity), including 7 achieving 20/60 or better. All 6 Aflibercept associated cases in the study were culture negative and 5/6 returned to their baseline visual acuity.
The endophthalmitis incidence rate after anti-VEGF injections at BPEI and in the commercial database was approximately 1/5000 and 1/3000 respectively. Treatment outcomes were variable but were generally better in the culture negative cases.
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