Abstract
Purpose :
The impact of systemic immunosuppressive therapy on the rates and outcomes of endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injections remains largely unexplored. The aim of this study was to examine whether systemic immunosuppressive therapy alters a patient’s risk for developing endophthalmitis after anti-VEGF injections.
Methods :
This is a retrospective, single-center cohort study examining all eyes that underwent intravitreal anti-VEGF injections (bevacizumab, ranibizumab, or aflibercept) from January 2016 to September 2019. Two cohorts (no immunosuppression vs immunosuppression) were created based on immunosuppressive status at time of intravitreal injection. The primary outcome was the occurrence of endophthalmitis rates, while visual acuity (VA) and culture-positive cases were secondary outcomes. Within both cohorts, patients who developed presumed post-injection endophthalmitis that underwent ocular tap with intravitreal antibiotics were identified and compared using Chi-Square or Mann-Whitney U. P < 0.05 was considered significant.
Results :
Of 270,347 anti-VEGF injections administered to 23,252 patients, 1300 (0.48%) injections were administered to 412 patients who were on systemic immunosuppressive therapy. In this cohort of eyes, five developed endophthalmitis for a rate of 0.38% (1 in 260 injections) compared to 100 eyes not on systemic immunosuppressants for a rate of 0.037% (1 in 2690 injections) with an odds ratio (OR) of 9.86 (95% CI: 4.0-24.3, P<0.001). Among the five eyes with presumed endophthalmitis, 3 had positive cultures (0.023%, 1 in 433 injections) compared to the 2 (0.012%, 1 in 8,407 injections) in the immunocompetent group for an OR of 19.4 [95% CI: 5.9-63.4, P<0.001]. Symptom onset occurred 2.51 (95% CI: 0.15-4.87, P=0.040) days earlier in the immunosuppressed patients; however, visual outcomes at 6 months were similar between the two groups.
Conclusions :
Eyes receiving intravitreal anti-VEGF injections who are concurrently on systemic immunosuppressive therapy may be at an increased risk for developing PIE. However, final visual outcomes following post-injection endophthalmitis treatment is similar regardless of systemic immunosuppression status. Additional studies are indicated to further elucidate the role, if any, of immunosuppressive therapy in the management of PIE.
This is a 2021 ARVO Annual Meeting abstract.