Comparison of endophthalmitis rates following intravitreal injection of compounded bevacizumab, ranibizumab, and aflibercept

Abstract

ObjectiveWhereas the incidence of endophthalmitis after compounded intravitreal bevacizumab is known to be low, the rates of endophthalmitis after intravitreal injection of compounded ranibizumab and aflibercept are not known. The purpose of this study was to determine the incidence of endophthalmitis after treatment with compounded intravitreal ranibizumab and aflibercept and to compare this to the incidence with compounded intravitreal bevacizumab. DesignRetrospective chart review. ParticipantsAll patients with post-injection endophthalmitis who were seen over a 6.5-year period at a tertiary retina referral practice. MethodsWe identified all cases of endophthalmitis by searching for patients who received intravitreal antibiotics and had antecedent intravitreal injection of bevacizumab, ranibizumab, or aflibercept. ResultsA total of 54,101 injections of bevacizumab, 5,614 injections of ranibizumab, and 3,468 injections of aflibercept were performed. The incidence of suspected endophthalmitis was 0.041% (95% CI: 0.026–0.062) for bevacizumab, 0.036% (95% CI: 0.0043–0.13) for ranibizumab, and 0.06% (95% CI: 0.007–0.2) for aflibercept. For culture-positive cases, the incidence was 0.017% (95% CI: 0.0076–0.032) for bevacizumab, 0.02% (95% CI: 0.0005–0.1) for ranibizumab, and 0.03% (95% CI: 0.0007–0.2) for aflibercept. There was no statistically significant difference in endophthalmitis rate between the 3 different compounded drugs with respect to both overall suspected endophthalmitis rate and culture-positive endophthalmitis rate (p = 0.87). ConclusionCompounding of ranibizumab and aflibercept for intravitreal use appears to be safe because the endophthalmitis rate does not appear to be different from that of intravitreal bevacizumab.