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 2018-2020 and compare the findings to characteristics of endophthalmitis after anti-VEGF injection from prior years.
Methods :
Retrospective case series of patients treated at a tertiary referral center between 01/01/2018 – 12/31/2020 with clinically diagnosed endophthalmitis occurring < 4 weeks after IV anti-VEGF injection.
Results :
Between 2018-2020, the rate of clinically diagnosed endophthalmitis was 0.013% (9/71,779) and of culture positive endophthalmitis was 0.008% (6/71,779). The endophthalmitis rates per injection were: aflibercept 0.020% (8/40,302); ranibizumab 0.019% (1/5,242); bevacizumab 0% (0/25,548); and brolucizumab 0% (0/687).
The overall rates of endophthalmitis among all injections from 2018-2020 are similar to previously published data of endophthalmitis after IV anti-VEGF from 2005-2017 (0.013% vs 0.013% [p=0.91]). The incidences of endophthalmitis after aflibercept and ranibizumab from 2018-2020 were slightly increased from 2005-2017, though these differences were not significant (aflibercept: 0.020% vs 0.014% [p=0.51]; ranibizumab: 0.019% vs. 0.016% [p=0.87]).
From 2018-2020, a total of 6 eyes had culture positive endophthalmitis. Associations included aflibercept (5/6) and ranibizumab (1/6). All cases of endophthalmitis occurred < 5 days after IV injection. The causative organisms were coagulase negative Staphylococcus (3/6), Streptococcus (2/6), and Abiotrophia defectiva, a nutritionally variant streptococci, (1/6). At final follow up, two eyes had achieved a visual acuity (VA) better than or equal to 20/200 and the two eyes infected with Streptococcus species required enucleation. The 3 eyes with negative cultures had received aflibercept injections and 2/3 achieved their pre-injection VA.
Conclusions :
Endophthalmitis rates after IV anti-VEGF remain low. Poor VA outcomes continue being associated with Streptococcus species. Nutritionally variant streptococci may be a rare cause of endophthalmitis after IV anti-VEGF injection.
This is a 2021 ARVO Annual Meeting abstract.