ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTION: Decreasing Incidence and Clinical Outcome—8-year Results from a Tertiary Ophthalmic Referral Center

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Abstract

Purpose:

To report the incidence, clinical features, microbiologic culture results, management and visual outcome of patients with endophthalmitis after intravitreal injections (IVTs).

Methods:

This retrospective chart review included all patients receiving IVTs between January 2005 and July 2012. Cases of suspected and confirmed endophthalmitis after IVT were identified and reviewed.

Results:

A total of 20,179 IVTs were perfomed during the study period. Six cases of supected endophthalmitis were identified clinically (0.03%), of which 3 were culture positive (0.015%). The risk of culture-positive post-IVT endophthalmitis was 2/8,882 (0.023%) in the 2005 to 2008 period and 1/11,297 (0.009%) in the period 2009 to 2012. Symptoms developed within the first 3 days after IVT in 4 of the 6 patients and visual acuity was reduced to hand motion in 4 of the 6 patients. Microbiologic specimens were positive on 3 of the 6 cases (coagulase-negative Staphylococcus, n = 2; Staphylococcus aureus, n = 1). Mean visual acuity before patients with endophthalmitis was 20/100, whereas mean final visual acuity at last follow-up was 20/200.

Conclusion:

The incidence of endophthalmitis after IVT was low with no cases because of Streptococcus species in the present setting using povidone-iodine in the preoperative disinfection of the conjunctival sac. Therefore, adherence to standardized protocols including the use of povidone-iodine when performing IVTs is recommended.

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