Incidence of endophthalmitis low after intravitreal injections of anti-VEGF drugs

Monitoring of the incidence of culture-proven endophthalmitis following anti-vascular endothelial growth factor (VEGF) intravitreal injections has indicated that the rate of clinically suspected infectious endophthalmitis is low after intravitreal injections of anti-VEGF agents over a period of 2.5 years, said Andrew Moshfeghi, MD, of the Bascom Palmer Eye Institute, University of Miami.

After 24,865 injections of anti-VEGF drugs (pegaptanib [Macugen, OSI/Eyetech/Pfizer], bevacizumab [Avastin, Genentech], and ranibizumab [Lucentis, Genentech]) were administered at the Bascom Palmer Eye Institute, Dr. Moshfeghi reported that a retrospective review of the cases showed that seven cases of clinically suspected endophthalmitis developed-five cases of which were culture-positive and two of which were culture-negative. The rate of endophthalmitis was 0.028% in the treated cases and 0.02% in the culture-positive cases. Most of the cases were gram-positive Streptococcus. Most patients returned to the baseline visual acuity level, but two patients developed no light perception vision.

"Endophthalmitis, which occurs uncommonly after routine injections, is a potentially sight-threatening complication," Dr. Moshfeghi said. "The incidence of endophthalmitis that we found at the Bascom Palmer Eye Institute is similar to the rates reported in the VISION, ANCHOR, and MARINA trials. For the foreseeable future, refractory patients will continue to receive from five to seven injections of these drugs annually. Ophthalmologists need to recognize endophthalmitis. Good visual outcomes can be seen, but severe cases also can develop."