Streptococcus most common cause of endophthalmitis in study

Harry W. Flynn Jr.

PHILADELPHIA — The rate of endophthalmitis following intravitreal injection of anti-VEGF agents was very low during a recent study, a speaker said here.

In a 6-year retrospective case series, Streptococcus isolates presented three to four times more frequently after intravitreal injection than after intraocular surgery, Harry W. Flynn Jr., MD, said at Macula 2011.

Doctors at Bascom Palmer Eye Institute and three university-owned satellite clinics reviewed clinical data for patients undergoing intravitreal injections from January 2005 to November 2010 and documented rates of endophthalmitis, Streptococcus and other clinical outcomes, Dr. Flynn said.

"Streptococcus species was the most common bacteria isolated, and it was generally associated with poor visual outcomes," he said.

Of seven culture-positive cases of endophthalmitis, five were caused by Streptococcus species, one by Staphylococcus epidermidis and one by Bacillus non-anthracis.

Twelve cases of clinically suspected endophthalmitis were identified out of 60,322 cases in 6 years.

Eleven of the twelve cases presented within 3 days of injection, Dr. Flynn said.

Seven of the cases presented after bevacizumab injection, while five presented after ranibizumab injection. No cases presented after injection with pegaptanib.

"Keep in mind, there were twice as many bevacizumab injections as there were ranibizumab," Dr. Flynn said.

Disclosure: Dr. Flynn has financial interests in Regeneron and has worked as a consultant for Alcon, Santen Pharmaceutical, Allergan, Eli Lilly and Pfizer.