Endophthalmitis After Intravitreal Anti-Vascular Endothelial Growth Factor Antagonists: A Six-Year Experience at a University Referral Center

Abstract

Purpose: : To assess the rate of as well as to describe the clinical and microbiological features of eyes that develop clinically suspected endophthalmitis following an intravitreal injection of vascular endothelial growth factor (VEGF) antagonists.

Methods: : The current study is a retrospective consecutive case series from a University-based referral center and three university-owned satellite clinics, of patients undergoing intravitreal injections of anti-VEGF agents from 01/01/2005 through 11/01/2010. The rates of endophthalmitis, clinical outcomes, and microbiological features are recorded.

Results: : Twelve cases (eleven patients) of clinically suspected endophthalmitis were identified out of a total of 12/58,453 (P=0.02, 95% confidence interval 0.0117 to 0.0359). . Eleven of the twelve cases presented within 3 days of the injection. Of the 7 culture-positive cases, 5 were due to Streptococcus species, 1 was due to Staphylococcus epidermidis, and 1 was due to Bacillus non-anthracis.Of the culture-positive cases, 3 achieved visual acuity of 20/100 or better, but 4 had hand motions or worse vision at last follow-up. In 4 of the 5 Streptococcus cases, final visual acuity was hand motions or worse. Four of the five culture negative cases, by contrast, achieved visual acuity better than 20/100. The rate of clinically suspected endophthalmitis was 0.023% after bevacizumab and 0.036% after ranibizumab.

Conclusions: : In the current 6-year study, there was a very low rate of endophthalmitis after intravitreal injection of anti-VEGF agents. Patients typically presented within three days of injection. Streptococcus species was the most common bacteria isolated and it was generally associated with poor visual outcomes.

Keywords: endophthalmitis • injection • microbial pathogenesis: clinical studies