title: Endophthalmitis after intravitreal vascular [corrected] endothelial growth factor antagonists: a six-year experience at a university referral center.
abstract: OBJECTIVE
  To assess the rate of infectious endophthalmitis and to describe the clinical and microbiological features of eyes that develop clinically suspected endophthalmitis after an intravitreal injection of vascular endothelial growth factor antagonists.
  
  
  METHODS
  The medical records of patients undergoing intravitreal injections of anti-vascular endothelial growth factor agents from January 1, 2005, through December 31, 2010, at a single university referral center and associated satellite clinics were retrospectively analyzed to determine the rate of infectious endophthalmitis after intravitreal anti-vascular endothelial growth factor injections.
  
  
  RESULTS
  Twelve cases (11 patients) of clinically suspected endophthalmitis were identified after a total of 60,322 injections (0.02%; 95% confidence interval, 0.0114%-0.0348%). Of the 12 cases, 11 presented within 3 days of the injection. Of the 7 culture-positive cases, 5 were because of Streptococcus species. In 4 of the 5 Streptococcus cases, final visual acuity was hand motions or worse. The rate of clinically suspected endophthalmitis was 0.018% after bevacizumab and 0.027% after ranibizumab injections.
  
  
  CONCLUSIONS
  A very low rate of endophthalmitis after intravitreal injections of anti-vascular endothelial growth factor agents was observed. Patients typically presented within 3 days of injection. Streptococcus species was the most common bacteria isolated, and it was generally associated with poor visual outcomes.
authors.affiliation: Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida 33418, USA. amoshfeghi@med.miami.edu
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Moshfeghi
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Rosenfeld
authors.forename: Harry W
authors.initials: HW
authors.lastname: Flynn
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Schwartz
authors.forename: Janet L
authors.initials: JL
authors.lastname: Davis
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Murray
authors.forename: William E
authors.initials: WE
authors.lastname: Smiddy
authors.forename: Audina M
authors.initials: AM
authors.lastname: Berrocal
authors.forename: Sander R
authors.initials: SR
authors.lastname: Dubovy
authors.forename: Wen-Hsiang
authors.initials: WH
authors.lastname: Lee
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Albini
authors.forename: Geeta A
authors.initials: GA
authors.lastname: Lalwani
authors.forename: Jaclyn L
authors.initials: JL
authors.lastname: Kovach
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Puliafito
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects; D052157:Aptamers, Nucleotide / Q000009:adverse effects; D001082:Aqueous Humor / Q000382:microbiology; D001419:Bacteria / Q000302:isolation & purification*; D000068258:Bevacizumab; D009877:Endophthalmitis / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab; D012017:Referral and Consultation; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity / Q000502:physiology; 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