Evaluation of the incidence of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor.

Abstract

AIMS:

To report the incidence of infectious and noninfectious endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor (VEGF) from a multicenter clinical trial in Japan.

METHODS:

A retrospective multicenter review of the data of patients who received intravitreal anti-VEGF injections between January 2007 and March 2011 was undertaken. Cases with the clinical diagnosis of endophthalmitis resulting from intravitreal injection were identified and reviewed.

RESULTS:

A total of 5,236 intravitreal anti-VEGF injections (1,209 intravitreal injections of bevacizumab, 3,827 injections of ranibizumab, and 200 injections of pegaptanib sodium) had been administered. Five patients (0.095%), all of whom had received bevacizumab, were diagnosed as having endophthalmitis after the intravitreal injection. All patients visited the institutes for re-examination within 1-2 days after the injection. Among the 5 patients, 2 (0.038%) were culture positive for Streptococcus oralis and Enterococcus faecalis, respectively. The remaining 3 eyes (0.057%) developed presumed noninfectious endophthalmitis.

CONCLUSION:

Although endophthalmitis is a rare complication associated with intravitreal injection, in this series intravitreal anti-VEGF injection caused infectious or noninfectious endophthalmitis at a relatively high frequency. Further investigations are needed to consider an appropriate injection protocol for minimizing the incidence rates of endophthalmitis, and to assess the optimal treatment protocol for intravitreal injection-related endophthalmitis although it was difficult to differentiate these two entities.

• Authors: Maiko Inoue, Shinichiro Kobayakawa, Chie Sotozono, Hideki Komori, Kumiko Tanaka, Yuzo Suda, Hiroyuki Matsushima, Shigeru Kinoshita, Tadashi Senoo, Tetsuo Tochikubo, Kazuaki Kadonosono
• Journal: Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde (Ophthalmologica) Vol. 226 Issue 3 Pg. 145-50 ( 2011) ISSN: 1423-0267 [Electronic] Switzerland
• PMID: 21811052 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2011 S. Karger AG, Basel.

Chemical References

• Angiogenesis Inhibitors
• Antibodies, Monoclonal, Humanized
• Aptamers, Nucleotide
• VEGFA protein, human
• Vascular Endothelial Growth Factor A
• pegaptanib
• Bevacizumab
• Ranibizumab

Topics

• Aged, 80 and over
• Angiogenesis Inhibitors (administration & dosage)
• Antibodies, Monoclonal, Humanized (administration & dosage)
• Aptamers, Nucleotide (administration & dosage)
• Aqueous Humor (microbiology)
• Bevacizumab
• Endophthalmitis (epidemiology, microbiology)
• Enterococcus faecalis (isolation & purification)
• Eye Infections, Bacterial (epidemiology, microbiology)
• Gram-Positive Bacterial Infections (epidemiology, microbiology)
• Humans
• Incidence
• Intravitreal Injections
• Japan (epidemiology)
• Middle Aged
• Postoperative Complications
• Ranibizumab
• Retrospective Studies
• Streptococcal Infections (epidemiology, microbiology)
• Streptococcus oralis (isolation & purification)
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)
• Vitreous Body (microbiology)