Endophthalmitis much more common after in-office injections

This retrospective study found a thirteenfold lower rate of endophthalmitis following intravitreal injections performed in an accredited operating theater compared to a nonaccredited in-office environment.

The authors reviewed the results of 12,249 ranibizumab or bevacizumab injections performed during a six-year period by the same surgeon, 3,376 of which were in the in-office procedure room and 8,873 in the operating theater. The in-office environment was designed to replicate the in-theater environment.

Of the injections performed in-office, there were four cases of infective endophthalmitis, compared with none resulting from the injections performed in-theater (P = 0.006). The incidence of endophthalmitis was 0.03 percent overall and 0.12 percent in the office setting.

The authors considered the potential for confounding bias created by the possibility of differences in socioeconomic status. Generally, patients who have their injections in-office are uninsured, while those who have injections in-theater have private health insurance. Data analysis indicated no significant difference between the groups, but the socioeconomic scores overall were very low compared with the national average.

The authors conclude that despite these results, there are many justifications for why in-office injections may be considered appropriate. In the absence of publicly-funded access to in-theater intravitreal injections, the need for treatment of the underlying disease outweighs the additional risk profile of in-office injections. Furthermore, in-office injections do provide some logistic advantages in situations in which therapy must be started immediately.