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  • Predictors of Postinjection Endophthalmitis

    By Jean Shaw
    Selected By: Andrew P. Schachat, MD
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    Journal Highlights

    Ophthalmology Retina, January 2019

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    Stem et al. set out to determine the incidence of endophthalmitis following anti-VEGF injections and to identify potential ways of lowering that risk. They found that the overall incidence of postinjection endophthalmitis was low—and that the use of lidocaine jelly or TetraVisc (tetracaine) may be associ­ated with an increased risk.

    For this retrospective single-center study, the authors assessed all patients in their practice who received an intravitreal injection of an anti-VEGF drug between Jan. 1, 2014, and March 31, 2017. All told, 154,198 intravitreal injections were given during this time, and 58 cases of endophthalmitis occurred, for a rate of 1:2,659. Less than half of these cases (24; 41%) were culture-positive.

    A number of risk factors were evaluated, including povidone-iodine (PVI) solution strength and the choice of anti-VEGF drug. No difference in endophthalmitis rates emerged among the anti-VEGF drugs (aflibercept, bevacizumab, and ranibizumab 0.3 mg and 0.5 mg). Moreover, the prophylactic use of 10% PVI neither reduced nor increased the risk of endophthalmitis relative to the use of a 5% PVI solution. In addition, no association emerged regarding several other potential risk factors, including lid speculum use, choice of injection site, or conjunctival displacement.

     However, both 2% lidocaine jelly and 0.5% TetraVisc emerged as inde­pendent risk factors. As the authors noted, this finding has not previously been reported and merits further inves­tigation.

    The original article can be found here.