Abstract

Purpose To evaluate the rate of presumed endophthalmitis (EO) after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections performed in an operating room (OR) under sterile conditions in mainland China. Methods Retrospective single-center study between September 2012 and December 2017 at Beijing Tongren Eye Center, Beijing, China. Intravitreal injection database was reviewed. All anti-VEGF injections were performed using a standardized sterile technique in an OR. Injection protocols included antibiotics for 3 days pre-injection, topical 5% povidone-iodine rinsing before the procedure, and post-injection antibiotics for 3 days. Results A total of 37,830 intravitreal injections were performed at Beijing Tongren Eye Center. Three cases were managed as presumed EO (0.0079%). Positive cultures were documented in 2 of 3 cases. EO incidence following ranibizumab and conbercept administration was 0.0088% (3 in 33,930) and 0% (0 in 3,900), respectively. No significant difference was detected between the two drugs (P = 0.745). Conclusions Very low EO rates were seen in mainland China using a standardized sterile technique in an OR. However, EO could not be completely avoided.

Highlights

  • Intravitreal anti-vascular endothelial growth factor injections are considered the standard treatment for patients with neovascular age-related macular degeneration (AMD), diabetic retinopathy (DR), and macular edema secondary to retinal vein occlusion

  • A total of 37,830 intravitreal anti-VEGF injections were performed at Beijing Tongren Eye Center from September 2012 to December 2017. ree cases of presumed EO were documented in 33,930 and 0 in 3,900

  • EO cases were presented in June 2014 (Case 1), June 2015 (Case 2), and May 2017 (Case 3), respectively

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Summary

Introduction

Intravitreal anti-vascular endothelial growth factor (antiVEGF) injections are considered the standard treatment for patients with neovascular age-related macular degeneration (AMD), diabetic retinopathy (DR), and macular edema secondary to retinal vein occlusion. The significant therapeutic benefits over the years have not been completely free of complications. There is always a risk of non-infectious or infectious endophthalmitis (EO). Non-infectious EO refers to a transient, self-limited inflammatory reaction, typically with hypopyon, presenting within the first few days after injections [1]. Infectious EO is overall the most feared complication of intravitreal injections. Typical bacterial EO presents with rapid visual loss, eye pain, conjunctival hyperemia, hypopyon, and vitreous opacification [2]. Bacterial infections account for the majority of such cases [3]

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