title: Postinjection endophthalmitis in the comparison of age-related macular degeneration treatments trials (CATT).
abstract: OBJECTIVE
  To describe the incidence and outcomes of endophthalmitis after intravitreal injections of anti-vascular endothelial growth factor agents in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) and to assess the effect of prophylactic topical antimicrobials on incidence.
  
  
  METHODS
  Cohort study within a randomized clinical trial.
  
  
  METHODS
  Patients enrolled in CATT.
  
  
  METHODS
  Patients with neovascular age-related macular degeneration received intravitreal injections of ranibizumab or bevacizumab under 1 of 3 dosing regimens. The study protocol specified preinjection preparation to include use of a sterile lid speculum and povidone iodine (5%). Use of preinjection and postinjection antibiotics was at the discretion of the treating ophthalmologist. Patients were followed up monthly for 2 years.
  
  
  METHODS
  Development of endophthalmitis and visual acuity.
  
  
  RESULTS
  Endophthalmitis developed after 11 of 18 509 injections (1 per 1700 [0.06%]; 95% confidence interval, 0.03%-0.11%), and in 11 of 1185 patients (0.93%; 95% confidence interval, 0.52-1.66). Incidence of endophthalmitis was 0.15% among injections with no antibiotic use, 0.08% among injections with preinjection antibiotics only, 0.06% among injections with postinjection antibiotics only, and 0.04% among injections with preinjection and postinjection antibiotics (P = 0.20). All eyes were treated with intravitreal antibiotics and 4 underwent vitrectomy. Among the 11 affected eyes, the final study visual acuity was 20/40 or better in 4 eyes (36%), 20/50 to 20/80 in 2 eyes (18%), 20/100 to 20/160 in 3 eyes (27%), and worse than 20/800 in 2 eyes (18%). The final visual acuity was within 2 lines of the visual acuity before endophthalmitis in 5 eyes (45%).
  
  
  CONCLUSIONS
  Rates of endophthalmitis were low and similar to those in other large-scale studies. Use of topical antibiotics either before or after injection does not seem to reduce the risk for endophthalmitis.
authors.affiliation: Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Travis A
authors.initials: TA
authors.lastname: Meredith
authors.affiliation: Department of Ophthalmology, University of California, Los Angeles, California.
authors.forename: Colin A
authors.initials: CA
authors.lastname: McCannel
authors.affiliation: Department of Ophthalmology, University of Louisville, Louisville, Kentucky.
authors.forename: Charles
authors.initials: C
authors.lastname: Barr
authors.affiliation: Retina Vitreous Consultants, Pittsburgh, Pennsylvania.
authors.forename: Bernard H
authors.initials: BH
authors.lastname: Doft
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Ellen
authors.initials: E
authors.lastname: Peskin
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: maguirem@mail.med.upenne.edu.
authors.forename: Maureen G
authors.initials: MG
authors.lastname: Maguire
authors.affiliation: Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Martin
authors.affiliation: Retina Vitreous Center, New Brunswick, New Jersey.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Prenner
mesh_terms: D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use; D000068258:Bevacizumab; D015331:Cohort Studies; D009877:Endophthalmitis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D000069579:Ranibizumab; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab