June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Presentation and outcomes of patients with post-injection endophthalmitis at a large academic center
Author Affiliations & Notes
  • Michael Ramos
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Srinidhi Singuri
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Lucy Xu
    Emory University, Georgia, United States
  • Julio Castillo
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Justis P Ehlers
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Peter M Kaiser
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Rishi P Singh
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Aleksandra Rachitskaya
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Sunil K Srivastava
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Jonathan E Sears
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Andrew Schachat
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Amy Babiuch
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Sumit Sharma
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Daniel F Martin
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Careen Y Lowder
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Alex Yuan
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Footnotes
    Commercial Relationships   Michael Ramos, None; Srinidhi Singuri, None; Lucy Xu, None; Julio Castillo, None; Justis Ehlers, Aerpio (F), Aerpio (C), Alcon (F), Alcon (C), Allegro (C), Allergan (F), Allergan (C), Genentech (F), Genentech/Roche (C), Leica (C), Leica (P), Novartis (F), Novartis (C), Regeneron (F), Regeneron (C), Santen (C), Thrombogenics/Oxurion (F), Thrombogenics/Oxurion (C), Zeiss (C); Peter Kaiser, Alcon (C), Allegro (C), Allergan (C), Bayer (C), Biogen Idec (C), Boehringer Ingelheim (C), Novartis (C), Oxurion (C), Regeneron (C), Santen (C), Takeda (C); Rishi Singh, Genentech (C), Novartis (C), Novartis (F), Regeneron (C), Zeiss (C); Aleksandra Rachitskaya, Alcon (C), Allergan (C), Genentech (F), Zeiss (C); Sunil Srivastava, Allergan (F), Bausch and Lomb (C), Clearside (C), Eyepoint (C), Gilead (F), Leica (P), Novartis (C), Regeneron (F), Regeneron (C), RegenerxBio (C), Santen (C), Zeiss (C); Jonathan Sears, None; Andrew Schachat, None; Amy Babiuch, Genentech (C), Regeneron (F); Sumit Sharma, Alimera (C), Allergan (C), Bausch and Lomb (C), Clearside (C), Eyepoint (C), Genentech (C), Regeneron (C); Daniel Martin, None; Careen Lowder, None; Alex Yuan, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 4410. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      Michael Ramos, Srinidhi Singuri, Lucy Xu, Julio Castillo, Justis P Ehlers, Peter M Kaiser, Rishi P Singh, Aleksandra Rachitskaya, Sunil K Srivastava, Jonathan E Sears, Andrew Schachat, Amy Babiuch, Sumit Sharma, Daniel F Martin, Careen Y Lowder, Alex Yuan; Presentation and outcomes of patients with post-injection endophthalmitis at a large academic center. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4410.

      Download citation file:


      © ARVO (1962-2015); The Authors (2016-present)

      ×
  • Supplements
Abstract

Purpose : Intravitreal injections are common treatments for many ocular diseases. While rare, complications such as endophthalmitis can occur. With this study, we report endophthalmitis rate, onset to presentation, clinical setting on presentation (ie: phone, office, or emergency room (ER)), and outcomes. Knowledge of presenting characteristics and overall outcomes can help guide future counseling of patients.

Methods : A retrospective, IRB-approved review of the electronic medical record system at a large academic center was performed. Intravitreal injections performed between 2012 to May 2019 were reviewed. Presumed endophthalmitis cases were identified by ICD-10 diagnosis codes H44.001, H44.002, H44.003, or H44.009 within 14 days of injection. Data collected included encounter type, days to presentation, and visual acuity outcomes.

Results : From 2012-May 2019, 84,973 injections were performed, and 33 cases (0.039%) of endophthalmitis relating to an injection were identified. 23 cases were culture-positive. 8 cases were culture-negative. In 2 cases, cultures were unavailable due to a dry tap. Average days to presentation were 4.4 and 4.2 (p=0.88) for culture-positive and –negative/unavailable cases, respectively. At office presentation, vision had decreased 14.2 and 14.1 lines (p=.98). Average line changes at 1, 6, and 12 months after initial presentation were not statistically different, however, vision was decreased from baseline at all timepoints. At 12 months, culture-positive and culture-negative/unavailable cases showed decreases of 7.0 and 6.1 lines, respectively (p=0.85).

Initial encounters showed 57.6% of endophthalmitis cases presenting in the office, 27.3% by phone, and 15.2% by ER. All initial phone encounters had a subsequent office visit. A control cohort of all non-infectious complications related to intravitreal injections presented with 65.4% by phone, 32.3% by office, and 2.3% by ER, which was statistically significant compared to the endophthalmitis cohort (X2= 20.18, p=7.0x10-6).

Conclusions : Endophthalmitis following intravitreal injection is uncommon, and the reported incidence (0.039%) is consistent with published reports. No statistical differences were found between culture-positive and –negative/unavailable groups in terms of days to presentation and average line change at 1, 6, and 12 months and both groups failed to return to baseline vision 12 months after encounter.

This is a 2020 ARVO Annual Meeting abstract.

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×