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Catherine P Garcher, Denis Dossarps, Philippe Koehrer, Serge Aho, Alain M Bron, FRCR net (FRenCh Retina specialists net); Endophthalmitis after Intravitreal Injections: incidence, presentation, management, and visual outcome . Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4798.
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To report the incidence and risk factors of endophthalmitis after intravitreal injections of antivascular endothelial growth factors or corticosteroids and to describe the clinical and bacteriological characteristics, management, and outcome of these eyes with acute endophthalmitis.
Retrospective, nationwide multicenter case series. From January 2, 2008 to June 30, 2013, 316,576 intravitreal injections from 25 ophthalmic centers were included. For each center, the number of intravitreal injections was determined using billing codes and the protocol of injection was recorded. A registry or hospital records were reviewed to identify patients treated for endophthalmitis after injection during the same time period.The main outcomes measures were the incidence of clinical endophthalmitis and visual acuity of endophthalmitis cases.
During the study period, 65 cases of presumed endophthalmitis were found, giving an overall incidence of 0.021% (2.1 in 10,000 injections) (95% confidence interval [CI], 0.016-0.026%). The median number of days from injection to presentation was 4 [1-26] days. The most common symptom was vision loss. Bacterial identification was achieved in 43.4%. The most frequent pathogens were Gram-positive bacteria (91.3%) including coagulase-negative Staphylococcus in 78.3%. Neither the interval between injection and presentation for endophthalmitis nor the clinical signs differentiated culture-positive from culture-negative cases. In multivariate analysis, the use of a disposable conjunctival mould and the use of prophylaxis with an antibiotic or antiseptic were significantly associated with an increased incidence of endophthalmitis (P = 0.001). The majority of patients had worse visual acuity after 3 months follow-up when compared with acuity before endophthalmitis.
The incidence of presumed endophthalmitis after intravitreal injections was low and the prognosis poor. Prevention and management remain challenging.
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