title: Endophthalmitis After Intravitreal Injections: Incidence, Presentation, Management, and Visual Outcome.
abstract: OBJECTIVE
  To report the incidence and characteristics of endophthalmitis after intravitreal injections of anti-vascular endothelial growth factor agents or corticosteroids and to describe the clinical and bacteriologic characteristics, management, and outcome of these eyes with acute endophthalmitis in France.
  
  
  METHODS
  Retrospective, nationwide multicenter case series.
  
  
  METHODS
  From January 2, 2008 to June 30, 2013, a total of 316,576 intravitreal injections from 25 French ophthalmic centers were included. For each center, the number of intravitreal injections was determined using billing codes and the injection protocol was recorded. A registry and hospital records were reviewed to identify patients treated for endophthalmitis after injection during the same time period. The main outcome measures were the incidence of clinical endophthalmitis and visual acuity of endophthalmitis cases.
  
  
  RESULTS
  During the study period, 65 cases of presumed endophthalmitis were found, giving an overall incidence of 0.021% (2.1 in 10,000 injections) (95% confidence interval [CI], 0.016%-0.026%). The median number of days from injection to presentation was 4 [1-26] days. The most common symptom was vision loss. Bacterial identification was achieved in 43.4%. The most frequent pathogens were gram-positive bacteria (91.3%), including coagulase-negative Staphylococcus in 78.3%. Neither the interval between injection and presentation for endophthalmitis nor the clinical signs differentiated culture-positive from culture-negative cases. In multivariate analysis, the use of a disposable conjunctival mould assist device and the use of prophylaxis with an antibiotic or antiseptic were significantly associated with an increased incidence of endophthalmitis (P = .001). The majority of patients had worse visual acuity after 3 months of follow-up when compared with acuity before endophthalmitis.
  
  
  CONCLUSIONS
  The incidence of presumed endophthalmitis after intravitreal injections of anti-vascular endothelial growth factors or corticosteroids was low and the prognosis poor. Prevention and management remain challenging. It remains to be determined whether the findings of this study are relevant for other countries using different techniques for intravitreal injections.
authors.affiliation: Department of Ophthalmology, Burgundy University, Dijon, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Dossarps
authors.affiliation: Department of Ophthalmology, Burgundy University, Dijon, France; Eye and Nutrition Research Group, CSGA, UMR 1324 INRA, 6265 CNRS, Burgundy University, Dijon, France.
authors.forename: Alain M
authors.initials: AM
authors.lastname: Bron
authors.affiliation: Department of Ophthalmology, Burgundy University, Dijon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Koehrer
authors.affiliation: Department of Epidemiology, Burgundy University, Dijon, France.
authors.forename: Ludwig S
authors.initials: LS
authors.lastname: Aho-Glélé
authors.affiliation: Department of Ophthalmology, Burgundy University, Dijon, France; Eye and Nutrition Research Group, CSGA, UMR 1324 INRA, 6265 CNRS, Burgundy University, Dijon, France. Electronic address: catherine.creuzot-garcher@chu-dijon.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Creuzot-Garcher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D009877:Endophthalmitis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D005260:Female; D005602:France / Q000453:epidemiology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D058449:Intravitreal Injections / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012164:Retinal Diseases / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors; D014792:Visual Acuity / Q000502:physiology*; D014822:Vitreous Body / Q000382:microbiology
chemical_list: D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; D005938:Glucocorticoids