title: LOW ENDOPHTHALMITIS RATES AFTER INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTIONS IN AN OPERATION ROOM: A Retrospective Multicenter Study.
abstract: OBJECTIVE
  To evaluate the rate of presumed endophthalmitis (EO) after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in three European hospitals performed in an operation room (OR) under sterile conditions.
  
  
  METHODS
  A retrospective multicenter study between 2003 and 2016 at three European sites, City Hospital Triemli Zurich, Switzerland (CHT), Zealand University Hospital Roskilde, Denmark (ZUH) and University Clinic Bern, Switzerland (UCB). Intravitreal injection (IVI) database of each department was reviewed. All anti-vascular endothelial growth factor injections were performed using a standardized sterile technique in an operation room. Injection protocols were similar between the three sites. No preinjection antibiotics were given. Postoperative antibiotics varied among sites.
  
  
  RESULTS
  A total of 134,701 intravitreal injections were performed at the 3 sites between 2003 and 2016. Ten cases of presumed endophthalmitis were documented: 4 in 50,721 at CHT (95% CI: 0.0071-0.0087%), 2 in 44,666 at ZUH (95% CI: 0.0039-0.0051%), and 4 in 39,314 at UCB (95% CI: 0.0092-0.011%). This results in one case in 13,470 intravitreal injections and a combined incidence of 0.0074% per injection (95% CI: 0.0070-0.0078%). Positive cultures were found in 4 out of 10 presumed endophthalmitis cases.
  
  
  CONCLUSIONS
  The standardized sterile technique in an operation room with laminar airflow showed very low rates of endophthalmitis at three European sites.
authors.affiliation: Department of Ophthalmology, City Hospital Triemli, Zurich, Switzerland.
authors.forename: Florentina J
authors.initials: FJ
authors.lastname: Freiberg
authors.affiliation: Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Troels
authors.initials: T
authors.lastname: Brynskov
authors.affiliation: Department of Ophthalmology, University Clinic Bern, Switzerland.
authors.forename: Marion R
authors.initials: MR
authors.lastname: Munk
authors.affiliation: Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Torben L
authors.initials: TL
authors.lastname: Sørensen
authors.affiliation: Department of Ophthalmology, University Clinic Bern, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wolf
authors.affiliation: Department of Ophthalmology, City Hospital Triemli, Zurich, Switzerland.
authors.forename: Magdalena A
authors.initials: MA
authors.lastname: Wirth
authors.affiliation: Department of Ophthalmology, City Hospital Triemli, Zurich, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Becker
authors.affiliation: Department of Ophthalmology, City Hospital Triemli, Zurich, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Michels
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D052157:Aptamers, Nucleotide / Q000008:administration & dosage; D000068258:Bevacizumab / Q000008:administration & dosage; D003718:Denmark / Q000453:epidemiology; D009877:Endophthalmitis / Q000453:epidemiology* / Q000209:etiology; D004866:Equipment Contamination / Q000706:statistics & numerical data; D015818:Eye Infections, Bacterial / Q000453:epidemiology* / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D058449:Intravitreal Injections / Q000009:adverse effects* / Q000295:instrumentation; D009873:Operating Rooms; D000069579:Ranibizumab / Q000008:administration & dosage; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery
chemical_list: D020533:Angiogenesis Inhibitors; D052157:Aptamers, Nucleotide; D011993:Recombinant Fusion Proteins; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; C495058:pegaptanib; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab