title: ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTION: Role of Prophylactic Topical Ophthalmic Antibiotics.
abstract: OBJECTIVE
  To determine the rate of postintravitreal injection endophthalmitis and to assess microbiological features and outcomes with and without the use of peri-intravitreal injection topical ophthalmic antibiotics.
  
  
  METHODS
  Consecutive series of endophthalmitis cases retrospectively identified after intravitreal injection at a multicenter, retina-only referral practice (Retina Consultants of Houston) from January 1, 2011 to December 31, 2014. Prophylactic peri-intravitreal injection topical antibiotics were routinely used during the initial 12-month period (January 1, 2011-December 31, 2011) and not used in the final 24-month period (January 1, 2013-December 31, 2014). Main outcome measures were incidence of endophthalmitis, microbiology results, treatment strategies, and visual outcomes.
  
  
  RESULTS
  Of 90,339 intravitreal injections, 30 cases of endophthalmitis were identified (endophthalmitis rate = 0.033%; 95% confidence interval, 0.021-0.045%; or approximately 1 of 3,011 intravitreal injections). The most common organisms isolated were coagulase-negative staphylococci (n = 10, 33%), followed by Streptococcus mitis (n = 2, 7%). Fourteen cases (47%) were culture negative. Peri-intravitreal injection topical antibiotic prophylaxis did not decrease the rate of endophthalmitis (0.035% [95% CI, 0.007-0.064%] with antibiotic use versus 0.021% [95% CI, 0.008-0.033%] without antibiotic use; P = 0.261).
  
  
  CONCLUSIONS
  The risk of endophthalmitis after intravitreal injection remains low, with coagulase-negative staphylococci and Streptococcus mitis the most common bacterial isolates identified. Prophylactic peri-intravitreal injection topical ophthalmic antibiotic use did not decrease the endophthalmitis rate.
authors.affiliation: *Retina Consultants of Houston, Houston, Texas; and †Blanton Eye Institute and Houston Methodist Hospital, Houston, Texas.
authors.forename: Alexa L
authors.initials: AL
authors.lastname: Li
authors.forename: Charles C
authors.initials: CC
authors.lastname: Wykoff
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.forename: Eric
authors.initials: E
authors.lastname: Chen
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Benz
authors.forename: Richard H
authors.initials: RH
authors.lastname: Fish
authors.forename: Tien P
authors.initials: TP
authors.lastname: Wong
authors.forename: James C
authors.initials: JC
authors.lastname: Major
authors.forename: David M
authors.initials: DM
authors.lastname: Brown
authors.forename: Amy C
authors.initials: AC
authors.lastname: Schefler
authors.forename: Rosa Y
authors.initials: RY
authors.lastname: Kim
authors.forename: Ronan E
authors.initials: RE
authors.lastname: OʼMalley
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D001419:Bacteria / Q000302:isolation & purification; D003930:Diabetic Retinopathy / Q000188:drug therapy; D009877:Endophthalmitis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D015818:Eye Infections, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy; D008269:Macular Edema / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D014222:Triamcinolone Acetonide / Q000627:therapeutic use; D014822:Vitreous Body / Q000382:microbiology
chemical_list: D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; D014222:Triamcinolone Acetonide