title: Incidence and clinical features of post-injection endophthalmitis according to diagnosis.
abstract: OBJECTIVE
  To compare the incidence and clinical features of endophthalmitis after intravitreal antivascular endothelial growth factor (VEGF) therapy for diabetic eye disease, neovascular age-related macular degeneration (AMD) and retinal vein occlusion (RVO).
  
  
  METHODS
  Multicentre, retrospective, consecutive case-control study. All patients treated with intravitreal bevacizumab, ranibizumab or aflibercept for diabetic eye disease, neovascular AMD or RVO between 1 January 2009 and 30 September 2013 at three retina practices were included in this study. The total number of anti-VEGF injections administered for the three indications was calculated using billing records. Endophthalmitis cases were identified using both endophthalmitis log sheets and billing records. Patient charts were reviewed to confirm that endophthalmitis was directly related to anti-VEGF injection and to record clinical features and culture results.
  
  
  RESULTS
  During the study period, a total of 353 978 intravitreal anti-VEGF injections were performed. Presumed infectious endophthalmitis occurred in 119 of 296 017 injections performed for neovascular AMD (1/2487, 0.040%), 12 of 24 541 for diabetic eye disease (1/2045, 0.049%) and 4 of 32 418 for RVO (1/8104, 0.012%). χ(2) analysis found endophthalmitis rates to be higher in diabetic eye disease compared with RVO (p=0.010) and higher in neovascular AMD compared with RVO (p=0.014), while diabetic eye disease and neovascular AMD (p=0.517) had similar rates. The average age of the overall neovascular AMD patient population (81.9 years) was significantly older than the diabetic eye disease (64.7 years, p<0.001) and RVO (73.4 years, p<0.001) populations.
  
  
  CONCLUSIONS
  Endophthalmitis rates appear to be lower in eyes with RVO compared with diabetic eye disease and neovascular AMD, possibly due to impaired immunity in diabetics and waning immunity in the generally older AMD population.
authors.affiliation: The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Nadim
authors.initials: N
authors.lastname: Rayess
authors.affiliation: The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Rahimy
authors.affiliation: Ophthalmic Consultants of Boston, Boston, Massachusetts, USA.
authors.forename: Chirag P
authors.initials: CP
authors.lastname: Shah
authors.affiliation: William Beaumont Hospital, Royal Oak, Michigan, USA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Wolfe
authors.affiliation: Retina Consultants of Houston, Houston, Texas, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Chen
authors.affiliation: Southeastern Retina Associates, Chattanooga, Tennessee, USA.
authors.forename: Francis C
authors.initials: FC
authors.lastname: DeCroos
authors.affiliation: The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Storey
authors.affiliation: The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Sunir J
authors.initials: SJ
authors.lastname: Garg
authors.affiliation: The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Hsu
mesh_terms: D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D009877:Endophthalmitis / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D058449:Intravitreal Injections / Q000009:adverse effects; D008297:Male; D012164:Retinal Diseases / Q000188:drug therapy*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D042461:Vascular Endothelial Growth Factor A
keywords: Infection; Microbiology; Retina