Endophthalmitis Associated with Intravitreal Injection of Anti-VEGF Agents at a Tertiary Referral Center from 2018-2019

Abstract

Purpose : To report the incidence and clinical features of infectious endophthalmitis after intravitreal (IV) injection of vascular endothelial growth factor inhibitors (anti-VEGF) from 2018-2019 and to compare these findings to the characteristics of endophthalmitis after anti-VEGF injection from 2005-2017.

Methods : Retrospective case series of clinical and microbiology records of patients treated at a tertiary referral center between 01/01/2018-10/31/2019 for clinically diagnosed endophthalmitis occurring ≤ 4 weeks after IV anti-VEGF injection.

Results : Following injections at our institution, the rate of clinically diagnosed endophthalmitis was 0.011% (5/44,196) and of culture positive endophthalmitis was 0.007% (3/44,196). The overall endophthalmitis rates per injection were as follows: aflibercept (clinically diagnosed 0.020% [5/24,965], culture positive 0.012% [3/24,965]); bevacizumab 0% (0/16,255); and ranibizumab 0% (0/2,976). The overall rates of endophthalmitis among all injections from 2018-2019 are similar to previously published data of endophthalmitis after IV anti-VEGF from 2005-2017 (clinically diagnosed 0.011% vs 0.013% [p=0.74], culture positive 0.007% vs 0.007%, [p=1.00]). However, the incidence of endophthalmitis after aflibercept from 2018-2019 was slightly increased from 2005-2017, though this difference was not significant (clinically diagnosed 0.020% vs 0.014% [p=0.53], culture positive 0.012% vs 0.004% [p=0.19]).

From 2018-2019, 7 eyes had culture positive endophthalmitis, 3 (43%) from injections performed at our institution and 4 from referred practices. All in house positive cultures resulted from aflibercept. Of the referred cases, 3/4 occurred after bevacizumab and 1/4 after aflibercept. All cases of endophthalmitis occurred ≤ 5 days after IV injection. The causative organisms were coagulase negative Staphylococcus (5/7) and Streptococcus (2/7). Only one eye achieved a VA better than 20/200 and the two eyes infected with Streptococcus required enucleation.

Conclusions : Endophthalmitis rates after IV anti-VEGF remain low and poor outcomes were associated with Streptococcus. These findings are similar to prior data from 2005-2017. However, in contrast to the 2005-2017 series in which ranibizumab was responsible for the majority of cases, aflibercept had the highest rate of endophthalmitis in 2018-2019 possibly due to the increased use of aflibercept.

This is a 2020 ARVO Annual Meeting abstract.