Global Reported Endophthalmitis Risk Following Intravitreal Injections of Anti-VEGF: a Literature Review and Analysis

Overview

Journal Clin Ophthalmol

Publisher Dove Medical Press

Specialty Ophthalmology

Date 2015 May 23

PMID 25999685

Citations 22

Authors

Douglas K Sigford

Shivani Reddy

Christine Mollineaux

Shlomit Schaal

Affiliations

Soon will be listed here.

Abstract

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.

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References

Gonzalez S, Rosenfeld P, Stewart M, Brown J, Murphy S . Avastin doesn't blind people, people blind people. Am J Ophthalmol. 2012; 153(2):196-203.e1. DOI: 10.1016/j.ajo.2011.11.023. View

Abell R, Kerr N, Allen P, Vote B . Intravitreal injections: is there benefit for a theatre setting?. Br J Ophthalmol. 2012; 96(12):1474-8. DOI: 10.1136/bjophthalmol-2012-302030. View

McCannel C . Meta-analysis of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents: causative organisms and possible prevention strategies. Retina. 2011; 31(4):654-61. DOI: 10.1097/IAE.0b013e31820a67e4. View

Kim S, Toma H . Ophthalmic antibiotics and antimicrobial resistance a randomized, controlled study of patients undergoing intravitreal injections. Ophthalmology. 2011; 118(7):1358-63. DOI: 10.1016/j.ophtha.2010.12.014. View

Goldberg R, Flynn Jr H, Isom R, Miller D, Gonzalez S . An outbreak of streptococcus endophthalmitis after intravitreal injection of bevacizumab. Am J Ophthalmol. 2012; 153(2):204-208.e1. PMC: 3266537. DOI: 10.1016/j.ajo.2011.11.035. View

Wen J, McCannel C, Mochon A, Garner O . Bacterial dispersal associated with speech in the setting of intravitreous injections. Arch Ophthalmol. 2011; 129(12):1551-4. DOI: 10.1001/archophthalmol.2011.227. View

Michels S, Rosenfeld P, Puliafito C, Marcus E, Venkatraman A . Systemic bevacizumab (Avastin) therapy for neovascular age-related macular degeneration twelve-week results of an uncontrolled open-label clinical study. Ophthalmology. 2005; 112(6):1035-47. DOI: 10.1016/j.ophtha.2005.02.007. View

Yamashiro K, Tsujikawa A, Miyamoto K, Oh H, Otani A, Tamuara H . Sterile endophthalmitis after intravitreal injection of bevacizumab obtained from a single batch. Retina. 2009; 30(3):485-90. DOI: 10.1097/IAE.0b013e3181bd2d51. View

Fintak D, Shah G, Blinder K, Regillo C, Pollack J, Heier J . Incidence of endophthalmitis related to intravitreal injection of bevacizumab and ranibizumab. Retina. 2008; 28(10):1395-9. DOI: 10.1097/IAE.0b013e3181884fd2. View

10.

Simunovic M, Rush R, Hunyor A, Chang A . Endophthalmitis following intravitreal injection versus endophthalmitis following cataract surgery: clinical features, causative organisms and post-treatment outcomes. Br J Ophthalmol. 2012; 96(6):862-6. DOI: 10.1136/bjophthalmol-2011-301439. View

11.

Wickremasinghe S, Michalova K, Gilhotra J, Guymer R, Harper C, Wong T . Acute intraocular inflammation after intravitreous injections of bevacizumab for treatment of neovascular age-related macular degeneration. Ophthalmology. 2008; 115(11):1911-5. DOI: 10.1016/j.ophtha.2008.05.007. View

12.

Heier J, Antoszyk A, Pavan P, Leff S, Rosenfeld P, Ciulla T . Ranibizumab for treatment of neovascular age-related macular degeneration: a phase I/II multicenter, controlled, multidose study. Ophthalmology. 2006; 113(4):633.e1-4. DOI: 10.1016/j.ophtha.2005.10.052. View

13.

Cheung C, Wong A, Lui A, Kertes P, Devenyi R, Lam W . Incidence of endophthalmitis and use of antibiotic prophylaxis after intravitreal injections. Ophthalmology. 2012; 119(8):1609-14. DOI: 10.1016/j.ophtha.2012.02.014. View

14.

Fielden M, Nelson B, Kherani A . Acute intraocular inflammation following intravitreal injection of bevacizumab--a large cluster of cases. Acta Ophthalmol. 2010; 89(8):e664-5. DOI: 10.1111/j.1755-3768.2010.02054.x. View

15.

Martin D, Maguire M, Ying G, Grunwald J, Fine S, Jaffe G . Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med. 2011; 364(20):1897-908. PMC: 3157322. DOI: 10.1056/NEJMoa1102673. View

16.

Elman M, Qin H, Aiello L, Beck R, Bressler N, Ferris 3rd F . Intravitreal ranibizumab for diabetic macular edema with prompt versus deferred laser treatment: three-year randomized trial results. Ophthalmology. 2012; 119(11):2312-8. PMC: 3490003. DOI: 10.1016/j.ophtha.2012.08.022. View

17.

Li T, Dickersin K . Citation of previous meta-analyses on the same topic: a clue to perpetuation of incorrect methods?. Ophthalmology. 2013; 120(6):1113-9. PMC: 4730544. DOI: 10.1016/j.ophtha.2012.11.038. View

18.

Mason 3rd J, White M, Feist R, Thomley M, Albert M, Persaud T . Incidence of acute onset endophthalmitis following intravitreal bevacizumab (Avastin) injection. Retina. 2008; 28(4):564-7. DOI: 10.1097/IAE.0b013e3181633fee. View

19.

Bhatt S, Stepien K, Joshi K . Prophylactic antibiotic use after intravitreal injection: effect on endophthalmitis rate. Retina. 2011; 31(10):2032-6. PMC: 4459136. DOI: 10.1097/IAE.0b013e31820f4b4f. View

20.

Mino de Kaspar H, Hoepfner A, Engelbert M, Thiel M, Ta C, Mette M . Antibiotic resistance pattern and visual outcome in experimentally-induced Staphylococcus epidermidis endophthalmitis in a rabbit model. Ophthalmology. 2001; 108(3):470-8. DOI: 10.1016/s0161-6420(00)00545-5. View