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Global reported endophthalmitis risk following intravitreal injections of anti-VEGF: a literature review and analysis

Authors Sigford D, Reddy S, Mollineaux C, Schaal S

Received 5 November 2014

Accepted for publication 27 November 2014

Published 2 May 2015 Volume 2015:9 Pages 773—781


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Douglas K Sigford,1 Shivani Reddy,1 Christine Mollineaux,2 Shlomit Schaal1

1Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, 2Department of Ophthalmology and Visual Science, University of Kentucky, Lexington, KY, USA

Purpose: To report on endophthalmitis occurrence and associated risk factors following the intravitreal injection of anti-VEGF agents based on a review of published literature.
Materials and methods: A Medline search was performed using the terms “bevacizumab” and “ranibizumab”. A total of 534 English-language articles of varying design and published from 2006 to November 2013 were analyzed for endophthalmitis occurrence and contributing perioperative factors.
Results: A total of 445,503 injections were counted. There were 103 cases of postinjection endophthalmitis in 176,124 injections (0.058%) with bevacizumab (Avastin) versus 79 cases in 269,379 injections (0.029%) with ranibizumab (Lucentis). This difference was due to a significantly higher occurrence of culture-negative endophthalmitis associated with bevacizumab injections. Culture-positive risk was not statistically different between the two drugs. The reported use of postinjection topical antibiotics increased the risk of culture-positive endophthalmitis. No association was found with the use of povidone iodine, a lid speculum, a mask, or an operating room. Streptococcus spp. were the most prevalent causative organism, accounting for nine of 54 (17%) of all culture-positive cases.
Conclusion: Reported postinjection endophthalmitis occurred significantly more in patients treated with bevacizumab than those treated with ranibizumab. However, culture-positive occurrence was similar. Despite the potential for contamination at the time of drug compounding, bevacizumab does not appear to confer a higher risk of culture-positive endophthalmitis than ranibizumab. This study also suggests antibiotic use may increase endophthalmitis occurrence.

Keywords: endophthalmitis, eye infections, intravitreal injections, panophthalmitis

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