Original article
Postinjection Endophthalmitis Rates and Characteristics Following Intravitreal Bevacizumab, Ranibizumab, and Aflibercept

https://doi.org/10.1016/j.ajo.2016.02.028Get rights and content

Purpose

To compare the incidence and clinical outcomes of endophthalmitis following intravitreal injections of bevacizumab, ranibizumab, and aflibercept.

Design

Multicenter, retrospective cohort study.

Methods

All included patients had received intravitreal injections of bevacizumab, ranibizumab, or aflibercept between January 1, 2009 and September 30, 2013 at 5 retina practices. Billing records were used to identify the total number of anti–vascular endothelial growth factor (VEGF) injections administered. Patients who developed endophthalmitis were ascertained from endophthalmitis logs and billing records. Chart review of these patients was performed to confirm that the endophthalmitis was related to the antecedent anti-VEGF injection. Visual outcomes, causative organisms, and clinical course were also recorded.

Results

A total of 503 890 anti-VEGF injections were included, from which 183 cases of presumed endophthalmitis were identified. The rate of endophthalmitis for bevacizumab was 0.039% (60/153 812), which was similar to ranibizumab 0.035% (109/309 722; P = .522) and aflibercept 0.035% (14/40 356; P = .693). Similarly, there was no difference in the rates between ranibizumab and aflibercept (P = .960). The culture-positive rate of the vitreous/aqueous tap was 38% for both bevacizumab and ranibizumab and was 43% for aflibercept. Furthermore, visual acuity remained decreased at 3 months follow-up for bevacizumab (P = .005), ranibizumab (P < .001), and aflibercept (P = .07) compared to vision at causative injection.

Conclusions

Endophthalmitis following intravitreal bevacizumab, ranibizumab, and aflibercept injection appears to occur at similar rates and have comparable visual outcomes. This study suggests that the choice of anti-VEGF agent should be primarily based on efficacy and patient response rather than concern for risk of infection.

Section snippets

Methods

This multicenter, retrospective cohort study received approval from the institutional review board (IRB) at Wills Eye Hospital and central Western IRB. The participating centers in this study include: The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA; Associated Retinal Consultants at William Beaumont Hospital, Royal Oak, Michigan, USA; Retina Consultants of Houston, Houston, Texas, USA; Ophthalmic Consultants of Boston, Boston, Massachusetts, USA;

Results

A total of 183 cases of endophthalmitis were identified from 503 890 anti-VEGF injections (1/2753 injections, 0.036%). Baseline characteristics for the 3 anti-VEGF agents are summarized in Table 1. From a total of 153 812 bevacizumab injections, 60 cases (1/2563 injections, 0.039%) of endophthalmitis occurred. For patients receiving ranibizumab injections, a total of 109 cases of postinjection endophthalmitis were reported from 309 722 ranibizumab injections (1/2841 injections, 0.035%). In the

Discussion

This study demonstrated that the rate of postinjection endophthalmitis is similar among eyes receiving intravitreal injections of bevacizumab, ranibizumab, and aflibercept. In addition, the percentage of culture-positive endophthalmitis cases was similar among the 3 agents. Coagulase-negative Staphylococcus and Streptococcus species were the first and second most commonly isolated organisms, respectively, for patients receiving bevacizumab and ranibizumab. For the aflibercept group,

References (24)

Cited by (91)

  • Guidance on brolucizumab management recommendations

    2022, Archivos de la Sociedad Espanola de Oftalmologia
View all citing articles on Scopus

Supplemental Material available at AJO.com.

View full text