title: Evaluation of the incidence of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor.
abstract: OBJECTIVE
  To report the incidence of infectious and noninfectious endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor (VEGF) from a multicenter clinical trial in Japan.
  
  
  METHODS
  A retrospective multicenter review of the data of patients who received intravitreal anti-VEGF injections between January 2007 and March 2011 was undertaken. Cases with the clinical diagnosis of endophthalmitis resulting from intravitreal injection were identified and reviewed.
  
  
  RESULTS
  A total of 5,236 intravitreal anti-VEGF injections (1,209 intravitreal injections of bevacizumab, 3,827 injections of ranibizumab, and 200 injections of pegaptanib sodium) had been administered. Five patients (0.095%), all of whom had received bevacizumab, were diagnosed as having endophthalmitis after the intravitreal injection. All patients visited the institutes for re-examination within 1-2 days after the injection. Among the 5 patients, 2 (0.038%) were culture positive for Streptococcus oralis and Enterococcus faecalis, respectively. The remaining 3 eyes (0.057%) developed presumed noninfectious endophthalmitis.
  
  
  CONCLUSIONS
  Although endophthalmitis is a rare complication associated with intravitreal injection, in this series intravitreal anti-VEGF injection caused infectious or noninfectious endophthalmitis at a relatively high frequency. Further investigations are needed to consider an appropriate injection protocol for minimizing the incidence rates of endophthalmitis, and to assess the optimal treatment protocol for intravitreal injection-related endophthalmitis although it was difficult to differentiate these two entities.
authors.affiliation: Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan. maicoo@urahp.yokohama-cu.ac.jp
authors.forename: Maiko
authors.initials: M
authors.lastname: Inoue
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Kobayakawa
authors.forename: Chie
authors.initials: C
authors.lastname: Sotozono
authors.forename: Hideki
authors.initials: H
authors.lastname: Komori
authors.forename: Kumiko
authors.initials: K
authors.lastname: Tanaka
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Suda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Matsushima
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kinoshita
authors.forename: Tadashi
authors.initials: T
authors.lastname: Senoo
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Tochikubo
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Kadonosono
mesh_terms: D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D052157:Aptamers, Nucleotide / Q000008:administration & dosage; D001082:Aqueous Humor / Q000382:microbiology; D000068258:Bevacizumab; D009877:Endophthalmitis / Q000453:epidemiology* / Q000382:microbiology; D013293:Enterococcus faecalis / Q000302:isolation & purification; D015818:Eye Infections, Bacterial / Q000453:epidemiology* / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D015994:Incidence; D058449:Intravitreal Injections; D007564:Japan / Q000453:epidemiology; D008875:Middle Aged; D011183:Postoperative Complications; D000069579:Ranibizumab; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000453:epidemiology / Q000382:microbiology; D019533:Streptococcus oralis / Q000302:isolation & purification; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014822:Vitreous Body / Q000382:microbiology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C495058:pegaptanib; D000068258:Bevacizumab; D000069579:Ranibizumab