title: Global reported endophthalmitis risk following intravitreal injections of anti-VEGF: a literature review and analysis.
abstract: OBJECTIVE
  To report on endophthalmitis occurrence and associated risk factors following the intravitreal injection of anti-VEGF agents based on a review of published literature.
  
  
  METHODS
  A Medline search was performed using the terms "bevacizumab" and "ranibizumab". A total of 534 English-language articles of varying design and published from 2006 to November 2013 were analyzed for endophthalmitis occurrence and contributing perioperative factors.
  
  
  RESULTS
  A total of 445,503 injections were counted. There were 103 cases of postinjection endophthalmitis in 176,124 injections (0.058%) with bevacizumab (Avastin) versus 79 cases in 269,379 injections (0.029%) with ranibizumab (Lucentis). This difference was due to a significantly higher occurrence of culture-negative endophthalmitis associated with bevacizumab injections. Culture-positive risk was not statistically different between the two drugs. The reported use of postinjection topical antibiotics increased the risk of culture-positive endophthalmitis. No association was found with the use of povidone iodine, a lid speculum, a mask, or an operating room. Streptococcus spp. were the most prevalent causative organism, accounting for nine of 54 (17%) of all culture-positive cases.
  
  
  CONCLUSIONS
  Reported postinjection endophthalmitis occurred significantly more in patients treated with bevacizumab than those treated with ranibizumab. However, culture-positive occurrence was similar. Despite the potential for contamination at the time of drug compounding, bevacizumab does not appear to confer a higher risk of culture-positive endophthalmitis than ranibizumab. This study also suggests antibiotic use may increase endophthalmitis occurrence.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, USA.
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Sigford
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, USA.
authors.forename: Shivani
authors.initials: S
authors.lastname: Reddy
authors.affiliation: Department of Ophthalmology and Visual Science, University of Kentucky, Lexington, KY, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Mollineaux
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, USA.
authors.forename: Shlomit
authors.initials: S
authors.lastname: Schaal
keywords: endophthalmitis; eye infections; intravitreal injections; panophthalmitis