Endophthalmitis following intravitreal injection of antiangiogenic agents A new study finds that the rate of infectious endophthalmitis following intravitreal injection of anti-VEGF agents is 0.077%.

A retrospective review of patients who received intravitreal injections of Avastin (bevacizumab), Lucentis (ranibizumab), and Macugen (pegaptanib sodium) was undertaken. Cases of clinical diagnoses of endophthalmitis or suspected endophthalmitis resulting from intravitreal injection were identified and reviewed. From these data, the risk per injection was estimated.

Three patients developed endophthalmitis after intravitreal injection. The risk per injection was 0.077%. The rate of endophthalmitis was 1 per 1,291 injections.

A similar risk of endophthalmitis per injection compared with other trials was obtained in this study. Although no definite risk factors could be identified, intravitreal injections performed by nonretina specialist physicians may be a risk factor for the development of endophthalmitis.


WHAT IT MEANS TO YOU: As surgeons have become more familiar with giving intravitreal injections, the risk of complications has fallen. However, there remains a small but important risk of endophthalmitis (intraocular infection). It is unlikely that preoperative prophylaxis and postoperative care will be able to completely eliminate the risk of endophthalmitis. Hence the importance of dosing regimens that decrease the number of injections as much as possible without sacrificing visual outcomes. Combination therapies, for example combining photodynamic therapy with anti-VEGF, is one strategy that is being explored as a means to decrease the need for retreatment. New therapies, such as VEGF-Trap, holds promise of requiring significantly fewer injections than currently available medications. Finally, topical (eye drop) agents currently in the drug pipeline may be able to completely eliminate the need for intravitreal injection in the treatment of neovascular AMD.

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Retina. 2009;29(5):601-605