Abstract
Purpose :
To investigate associations between patient-related factors, provider-related factors, and the risk of postinjection endophthalmitis.
Methods :
Retrospective nationally-representative sample of Medicare beneficiaries undergoing ≥1 intravitreal injection between January 1,2013 and December 31, 2017. Logistic regression analysis was performed to assess whether patient-related factors (age at injection, race, sex, agent injected, injection-associated diagnosis, year of injection), and provider-related factors (retina subspecialist versus non-subspecialist, board certification status) were associated with an increased or decreased risk of postinjection endophthalmitis. Main outcomes were measured with odds ratio (OR) with 95% confidence intervals of receiving a diagnosis of endophthalmitis in the 14 days after intravitreal injection.
Results :
2,907,324 intravitreal injections were performed on 219,640 patients by 4,315 ophthalmologists, 3,196 (74%) who were retina specialists and 4,021 (92%) who were certified by the American Board of Ophthalmology (ABO). The mean (SD) age of the patients was 78.2 (10.2), there were 131,284 females (59.8%), and 192,544 whites (87.7%), and 13,220 blacks (6.0%). Overall, there were 1,088 (0.037%) cases of postinjection endophthalmitis, 1,024 (0.037%) among patients receiving injections by ABO certified ophthalmologists and 64 (0.050%) by non-ABO-certified ophthalmologists (p=0.01). Patients receiving injections by ABO-certified ophthalmologist had a 28% reduced odds of endophthalmitis (OR=0.72; 95% CI: 0.523-0.996, P = 0.047). Subspeciality training in retina was not associated with the rate of endophthalmitis (OR=1.00; 95% CI: 0.734-1.362 P = 1.00).
Conclusions :
ABO board certification was associated with decreased odds of endophthalmitis after intravitreal injection. While some risk factors are not modifiable, restricting intravitreal injection to board certified ophthalmologists may reduce the risk of sight-threatening postinjection endophthalmitis.
This is a 2021 ARVO Annual Meeting abstract.