title: Endophthalmitis after intravitreal injection: decreasing incidence and clinical outcome-8-year results from a tertiary ophthalmic referral center.
abstract: OBJECTIVE
  To report the incidence, clinical features, microbiologic culture results, management and visual outcome of patients with endophthalmitis after intravitreal injections (IVTs).
  
  
  METHODS
  This retrospective chart review included all patients receiving IVTs between January 2005 and July 2012. Cases of suspected and confirmed endophthalmitis after IVT were identified and reviewed.
  
  
  RESULTS
  A total of 20,179 IVTs were perfomed during the study period. Six cases of supected endophthalmitis were identified clinically (0.03%), of which 3 were culture positive (0.015%). The risk of culture-positive post-IVT endophthalmitis was 2/8,882 (0.023%) in the 2005 to 2008 period and 1/11,297 (0.009%) in the period 2009 to 2012. Symptoms developed within the first 3 days after IVT in 4 of the 6 patients and visual acuity was reduced to hand motion in 4 of the 6 patients. Microbiologic specimens were positive on 3 of the 6 cases (coagulase-negative Staphylococcus, n = 2; Staphylococcus aureus, n = 1). Mean visual acuity before patients with endophthalmitis was 20/100, whereas mean final visual acuity at last follow-up was 20/200.
  
  
  CONCLUSIONS
  The incidence of endophthalmitis after IVT was low with no cases because of Streptococcus species in the present setting using povidone-iodine in the preoperative disinfection of the conjunctival sac. Therefore, adherence to standardized protocols including the use of povidone-iodine when performing IVTs is recommended.
authors.affiliation: Department of Ophthalmology, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Martin M
authors.initials: MM
authors.lastname: Nentwich
authors.forename: Yazmin
authors.initials: Y
authors.lastname: Yactayo-Miranda
authors.forename: Fabian
authors.initials: F
authors.lastname: Schwarzbach
authors.forename: Armin
authors.initials: A
authors.lastname: Wolf
authors.forename: Anselm
authors.initials: A
authors.lastname: Kampik
authors.forename: Herminia
authors.initials: H
authors.lastname: Mino de Kaspar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D009877:Endophthalmitis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D015818:Eye Infections, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D058449:Intravitreal Injections / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011206:Povidone-Iodine / Q000627:therapeutic use; D012017:Referral and Consultation; D012164:Retinal Diseases / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000302:isolation & purification; D062606:Tertiary Care Centers; D014792:Visual Acuity / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine