Abstract
Purpose :
Endophthalmitis is a rare vision-threatening complication of intravitreal (IVI) injection. IVI antibiotics are considered first-line management, yet there is lack of consensus regarding number and timing of repeat antibiotic injections as well as timing of pars plana vitrectomy (PPV) in eyes ultimately requiring surgery. We conducted a retrospective aggregated health records analysis to characterize practice patterns in management of post-IVI injection endophthalmitis in the United States (US). We sought to further delineate differences by region.
Methods :
We performed an analysis of eyes receiving IVI of anti-vascular endothelial growth factor (anti-VEGF) who subsequently developed endophthalmitis within 2 weeks of injection between January 1, 2014 and November 30, 2022. Data were obtained using the Vestrum Health Retina Database, which represents a geographically diverse sample of US retina specialists. We excluded eyes who underwent PPV with concurrent diagnosis of retinal detachment. Descriptive statistics were used to characterize endophthalmitis cases as well as frequency of antibiotic injections and timing of PPV.
Results :
Among 706,849 eyes receiving IVI anti-VEGF injections between 2014 and 2022, 2213 (0.31%) were diagnosed with endophthalmitis within 2 weeks of injection. Of these 2213 eyes, 762 (34%) were treated with bevacizumab, 964 (44%) with aflibercept, and 464 (21%) with ranibizumab. Most common indication for anti-VEGF therapy was neovascular age-related macular degeneration (n=1278; 58%). Average number of days between cauastive injection and endophthalmitis diagnosis was 4.8 (standard deviation [SD] 2.9). Most cases (n=1432; 65%) were managed with intravitreal antibiotics alone. Among 222 (10%) eyes undergoing PPV, average time to PPV was 7.5 (SD 6) days; 83 (4%) underwent PPV without in-office IVI antibiotic. PPV rates were highest in the Southwest (17%) and lowest in the Southeast (6%) (p<0.001). Few eyes (n=91; 4%) received a second antibiotic injection. Average interval between initial and second IVI antibiotic was 4.1 (SD 3.6) days. Repeat antibiotic injection rates were lowest in the Northeast (1.5%) and highest in the Midwest (5.8%) (p=0.001).
Conclusions :
In the US, most eyes with post-injection endophthalmitis were managed with IVI antibiotics alone. Repeat antibiotic injections were uncommon. Regional differences exist in rates of PPV and repeat antibiotic injection.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.