Endophthalmitis After Intravitreal Injection at an Academic Center

Abstract

Purpose : To determine the overall rate of post-intravitreal injection endophthalmitis and causative agents at an academic center. In addition, we report the management and long-term outcomes of these cases.

Methods : This is a retrospective consecutive case series of acute endophthalmitis (<4 weeks) following intravitreal injection at an academic center from January 2012 to November 2018. Cases were identified using billing and diagnosis codes for endophthalmitis occurring within 1 month of an intravitreal injection. The patients’ management, outcome, and the microbiologic data were recorded.

Results : Of 10,588 intravitreal injections, nine cases (0.085%; 95% confidence interval, 0.030%-0.141%) of post-intravitreal injection endophthalmitis were identified during the study period. The most common condition being treated was neovascular age-related macular degeneration (4/9; 44%). The most common medications identified were bevacizumab (3/9; 33%) and aflibercept (3/9; 33%). Three patients had negative culture. Six had positive culture, and coagulase-negative Staphylococci (3/6; 50%) was the most common organism isolated. Other isolates included Staphylococcus Aureus(1/6; 17%), Pseudomonas Aeruginosa(1/6; 17%), and Serratia Marcescens(1/6; 17%). Initial management consisted of vitreous tap and intravitreal antibiotics in 4 of 9 (44%) patients and vitrectomy and intravitreal antibiotics in 5 of 9 (56%) patients. Post-infection visual acuity outcomes ranged from 20/60 to no light perception, with one patient requiring enucleation.

Conclusions : The rate of endophthalmitis after intravitreal injection (0.085%) in our study is very low and consistent with previous studies. The most common bacterial isolate identified was coagulase-negative Staphylococci.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.