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A. A. Moshfeghi, H. W. Flynn, Jr., T. G. Murray, P. J. Rosenfeld, J. Gaitan, G. A. Lalwani, B. Lujan, P. Gallogly; Endophthalmitis Following Intravitreal Injections Is Very Rare in the Anti-VEGF Era. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2867.
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© ARVO (1962-2015); The Authors (2016-present)
To report the rate of infectious endophthalmitis following intravitreal injections of pegaptanib, ranibizumab, and bevacizumab at the Bascom Palmer Eye Institute.
Retrospective, non-comparative case series. The medical records of patients undergoing intravitreal injections of non-endophthalmitis related intravitreal anti-VEGF agents at the Bascom Palmer Eye Institute from January 1, 2005 to November 1, 2007 were examined. The medical records of patients who had suspected infectious endophthalmitis following an intravitreal injection were reviewed. All patients receiving intravitreal injections underwent a povidone iodine prep and were given topical antibiotics immediately after (but, not before) the intravitreal injection.
Over the study period, 19,830 intravitreal injections were performed. Three patients (0.015%) were treated for clinically suspected endophthalmitis. One case had negative vitreous cultures following an intravitreal injection of an anti-VEGF agent. This patient presented 3 days after a ranibizumab injection with visual acuity of hand motions, conjunctival injection, and hypopyon. It should be noted that this patient mistakenly used his pet dog's medicated ear drops postinjection in lieu of the prescribed prophylactic moxifloxacin drops. He was treated with intravitreal vancomycin, ceftazidime, and dexamethasone; intraocular cultures were negative. After 12 months follow-up, visual acuity has improved to baseline levels and he has several additional ranibizumab and bevacizumab injections without adverse sequelae. Two patients (0.010%) who were treated developed positive vitreous cultures. Both patients presented one day following intravitreal injections of bevacizumab and ranibizumab for CME due to CRVO (Streptococcus sanguinis/gordoni) and wet AMD (Staphylococcus epidermidis), respectively. Both culture positive cases were treated with intravitreal vancomycin, ceftazidime, and dexamethasone. The case with S. sanguinis/gordoni deterioated to no light perception visual acuity, having developed a complex retinal and choroidal detachment. The case with S. epidermidis had a good outcome with the visual acuity at 6 months returning to baseline.
A very low rate of clinically suspected infectious endophthalmitis (0.015%) following nearly 20,000 intravitreal injections of anti-VEGF agents was observed over the last 2 years at a single institution.
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