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  • Endophthalmitis Following Bilateral Same-Day Anti-VEGF Injection

    By Mike Mott
    Selected By: Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, October 2018

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    The most common indications for intravitreal anti–vascular endothelial growth factor (VEGF) therapy often require chronic treatment in both eyes. As a result, retina specialists routinely opt for bilateral same-day injections to reduce the number of office visits necessary for patients. Many clinicians, however, avoid this protocol for fear of bilateral endophthalmitis. To alleviate such concerns, Borkar et al. examined the results of more than 100,000 anti-VEGF injections and found low rates of infection.

    This retrospective cohort study in­cluded a review of a private practice’s records for all bilateral same-day anti-VEGF injections performed from 2012 to 2017. The researchers collected demographic information for all patients as well as information relating to presen­tation examination, culture data, and visual outcomes.

    During the 5-year span, the practice performed 101,932 bilateral same-day injections for 5,890 patients during 50,966 office visits. The number of these injections increased from ap­proximately 870 injections per month in 2012 to 2,300 in 2017. Neovascular age-related macular degeneration (AMD) and diabetic macular edema (DME) were the most common indica­tions for treatment. The most common agent used for neovascular AMD was ranibizumab. Aflibercept was the most common drug used for DME.

    In total, the authors identified 28 cases (0.027%) of unilateral endoph­thalmitis—approximately 1 in 3,700 injections—and found no instances of bilateral endophthalmitis. No patient experienced more than a single occur­rence.

    These results, the authors noted, demonstrate the safety of bilateral same-day anti-VEGF injections when extreme caution is taken to prevent infection—a finding that is especially important as the number of patients re­quiring anti-VEGF treatment continues to grow.

    The original article can be found here.