title: Endophthalmitis associated with intravitreal anti-vascular endothelial growth factor therapy injections in an office setting.
abstract: OBJECTIVE
  To determine the incidence of endophthalmitis following intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents.
  
  
  METHODS
  A retrospective interventional case series.
  
  
  METHODS
  A total of 10,254 intravitreal anti-VEGF injections (406 pegaptanib, 3,501 bevacizumab, and 6,347 ranibizumab) were performed from January 5, 2005 to October 18, 2007. The number of the injections was determined from the injection log books and billing records. The injections were performed as an office based procedure with use of povidone-iodine as a part of preinjection preparation. Preinjection antibiotics, eye drape, or surgical attire were not used. The main outcome measures were the incidence of suspected and proven endophthalmitis.
  
  
  RESULTS
  There were three cases of suspected endophthalmitis, one case following bevacizumab injection and two cases following ranibizumab injection. There was no case of culture-proven endophthalmitis. All three patients regained their preinjection visual acuity. The incidence of suspected endophthalmitis was 0.029% (95% confidence interval, 0.006% to 0.085%). There was no difference in the incidence of endophthalmitis between ranibizumab and bevacizumab injections (P = .6).
  
  
  CONCLUSIONS
  Although there is no consensus regarding the intravitreal injection procedure technique, the incidence of suspected endophthalmitis was very low in a large series of injected patients in a community setting and the incidence compares favorably with that reported in clinical trials where much more extensive preinjection preparation was mandated. We found no difference in the endophthalmitis risk of patients receiving bevacizumab as compared with ranibizumab.
authors.affiliation: Vitreous Retina Macula Consultants of New York, NY, USA.
authors.forename: Suman
authors.initials: S
authors.lastname: Pilli
authors.forename: Athanasios
authors.initials: A
authors.lastname: Kotsolis
authors.forename: Richard F
authors.initials: RF
authors.lastname: Spaide
authors.forename: Jason
authors.initials: J
authors.lastname: Slakter
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
authors.forename: John
authors.initials: J
authors.lastname: Sorenson
authors.forename: James
authors.initials: J
authors.lastname: Klancnik
authors.forename: Michael
authors.initials: M
authors.lastname: Cooney
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide / Q000009:adverse effects; D000068258:Bevacizumab; D009877:Endophthalmitis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D015817:Eye Infections / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007267:Injections; D008297:Male; D000069579:Ranibizumab; D012189:Retrospective Studies; D012307:Risk Factors; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity; D014822:Vitreous Body
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide; D042461:Vascular Endothelial Growth Factor A; C495058:pegaptanib; D000068258:Bevacizumab; D000069579:Ranibizumab