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Anna Gabrielian, Colin T. Flood, Timothy P. Flood; Trends In The Incidence & Outcomes Of Endophthalmitis After Anti-vascular Endothelial Growth Factor (anti-vegf) Injections In The Last Seven Years. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1698.
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To determine overall and yearly incidences of post-injection endophthalmitis in the last seven years.
Retrospective chart review of patients undergoing intravitreal injections of anti-VEGF agents from 06/2005 - 11/2011 in a multi-surgeon, multi-office retina practice. Post-surgical cases and those secondary to trauma and endogenous sources were excluded. Main outcomes were overall and yearly rates of post-injection endophthalmitis. Secondary outcome was final visual acuity (VA).
17 cases of clinically suspected endophthalmitis were identified in a total of 53,264 injections of anti-VEGF agents, with incidence of 0.03% [95% CI 0.02-0.05%]. Yearly incidence of endophthalmitis from 2005- 2007 was 0.04%, 0.05% and 0.4% in each year respectively. Yearly incidence from 2008 - 2010 was 0.03%, 0.04% and 0.03% respectively, and 0% in 2011.Average length of follow-up was 23.6 months (range 1-72.5 mo), with 2,201 intraocular injections of Macugen, 15,455 injections of Avastin, and 35,608 injections of Lucentis. No difference was noted in endophthalmitis rates between any of the anti-VEGF agents (p > 0.1 for all groups).Average time from injection to presentation was 52.4hrs (range 5 hrs - 11 days). Incidence of culture-positive endophthalmitis was 0.02% [95% CI 0.01-0.03%]. Mean time to presentation was 27hrs in culture-positive and 106hrs in culture-negative cases (p=0.03). Majority (67%) were streptococcal infections.LogMAR of baseline VA was 0.79 (range 0 - 2.3) on average. LogMAR of presenting VA was 1.96 (range 0.2 - 2.7), and logMAR of final VA was 1.39 (range 0.3 - 3) on average. Only 29.5% of patients returned to baseline VA.
The overall incidence of post-injection endophthalmitis was 0.03%, and the incidence of culture-positive endophthalmitis was 0.02%. Choice of anti-VEGF agent did not affect these rates. Culture-positive cases presented sooner. Fortunately, yearly incidence of endophthalmitis has been dropping over the past seven years. This could be due to the increased awareness of oral pathogen virulence, and undertaking of special precautions to minimize oropharyngeal droplet transmission. Since only 29.5% of patients returned to the baseline VA, post-injection endophthalmitis remains a vision-threatening entity in the age of anti-VEGF injections.
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