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Ilyse Kornblau, Hamza Pasha, Clark Andersen, Jaafar El-Annan; Does size really matter? Comparing rates of endophthalmitis following intravitreal injections using 30 vs. 32 gauge needles. Invest. Ophthalmol. Vis. Sci. 2018;59(9):6183.
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Endophthalmitis has been reported to occur at a rate of 0.021-0.058% following intravitreal (IVT) injections. Various needle gauges are used to perform IVT injections creating different size tracks in the sclera through which micro-organisms can pass seeding the vitreous and causing endophthalmitis. Reported risk factors associated with increased rates of endophthalmitis include failure to use povidone-iodine prep pre-injection, ophthalmic disease state, and post-operative antibiotic use. Presently there are no large volume published studies examining the rates of endophthalmitis between different small gauge needles. We examine the incidence of endophthalmitis following intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) using 30 vs. 32 gauge needles.
A retrospective chart review of 6,096 cases of patients >18 years of age who received anti-VEGF IVT injections at a multisite tertiary care institution from December 2013 to December 2016 were identified and data collected on patient age, gender, disease state, eye injected, medication injected, needle gauge, number of prior injections, provider, and clinical site. Data was analyzed for the incidence of endophthalmitis between 30 and 32 gauge needles after IVT injection.
A total of 773 eyes in 600 patients received 5,601 anti-VEGF IVT injections. One-fifth of the patients (126/600) were incarcerated in the Texas Department of Criminal Justice. Overall, 933 injections (16.7%) were performed using a 30 gauge needle vs. 4,668 (83.3%) using a 32 gauge needle. Patients in the 30 gauge needle group tended to be male (84.1% vs. 43.4%, p <0.01), younger (50-75 years old- 62.4% vs. 38.7%, p <0.01; >75 years old- 24.3% vs. 56.2%, p <0.01), and incarcerated (71.5% vs. 0.4%, p <0.01). Injections using a 30 gauge were more commonly performed by residents (71.8%) for diabetes mellitus (53.4%), while injections using a 32 gauge tended to be performed by faculty (91.2%, p >0.01) for ARMD (55.5%, p>0.01). The majority of patients received Bevacizumab (96.2%, 65.1%). A single case of endophthalmitis was identified following injection with a 30 gauge needle (0.0011%) versus none in the 32 gauge group.
There was a slightly increased rate of endophthalmitis following IVT injection using 30 gauge needles; however this study is limited by its small sample size and retrospective nature.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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