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Durga S Borkar, Anthony Obeid, Daniel Su, Philip Storey, Xinxiao Gao, Richard Kaiser, Sunir Garg, Jason Hsu; Endophthalmitis Rates after Bilateral Same Day Intravitreal Anti-VEGF Injections. Invest. Ophthalmol. Vis. Sci. 2018;59(9):6185.
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Neovascular age related macular degeneration and diabetic macular edema are the most common diseases requiring ongoing intravitreal anti-VEGF injections and often require bilateral treatment. Practice patterns vary in performing bilateral same day intravitreal injections. The purpose of this retrospective, observational study is to evaluate practice patterns for bilateral same day intravitreal anti-VEGF injections and determine the rate of post-injection endophthalmitis.
The medical and billing records of a large academic private practice in Philadelphia, PA were electronically queried for all office visits during which bilateral intravitreal anti-VEGF injections were performed between April 1, 2012 and August 21, 2017. Demographic information, as well as indication for injection, were recorded for each patient and office visit. An additional query was done to identify all cases of endophthalmitis based on both ICD-9 or ICD-10 diagnosis codes, as well as procedure billing codes. Charts of patients with endophthalmitis were individually reviewed, and information was collected on presentation vision and exam, culture data, and visual outcomes.
During the study period, 104,372 bilateral same day intravitreal anti-VEGF injections were performed over 52,171 office visits for 6,009 patients. The mean (standard deviation) age of patients in this cohort was 73.8 (14.4) years and 60.5% of patients were female. Of the 104,372 injections, 69,396 injections (66.5%) were performed for neovascular age related macular degeneration, while 28,096 injections (26.9%) were performed for diabetic macular edema. The most common anti-VEGF agent used was ranibizumab (55,051 injections), followed by aflibercept (32,542 injections) and bevacizumab (14,339 injections). Twenty-eight cases of endophthalmitis (0.027%) occurred during the study period. There were no cases of bilateral endophthalmitis, and no patients had more than one occurrence of endophthalmitis.
Practice patterns for bilateral injections vary, and some retina specialists perform injections for patients with bilateral pathology at separate visits given concern for bilateral endophthalmitis. In this large cohort of patients undergoing bilateral intravitreal anti-VEGF injections, there were no cases of bilateral endophthalmitis. Additionally, the overall rate of endophthalmitis was low and comparable to prior studies of unilateral injections.
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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