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Endophthalmitis rate after intravitreal injections comparable to rate after cataract surgery

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BARCELONA — Data from the Swedish Macula Register showed steady growth of intravitreal injection volume over the last 7 years and a stable low incidence of endophthalmitis with a slight increase in 2014.

“Between 2007 and 2014, we had 18,802 patients, 21,811 eyes, 304,401 visits and 145,747 treatments. Numbers have been growing steadily. Treatments were just over 2,000 in 2007 and nearly 36,000 in 2014,” Inger Westborg, MD, said at the European Society of Cataract and Refractive Surgeons meeting here.

Inger Westborg

The cases of endophthalmitis steadily grew proportionally to the number of injections. The highest number was in 2014, with 16 cases, 15 of which occurred in women. There were 46 registered cases of postop endophthalmitis between 2007 and 2014.

“The overall incidence is 0.032% per intravitreal injection and 0.24% per patient, about the same as for cataract surgery, with an increase last year to 0.04%,” Westborg said.

The register showed that treatment choices in Sweden changed over time toward increased use of bevacizumab in 2011-2012, following the results of the CATT study, and fast implementation of aflibercept in 2013-2014. In December 2014, 25% of injections were ranibizumab, 24% bevacizumab and 51% aflibercept. Of the 16 cases of endophthalmitis reported in 2014, five occurred after aflibercept injection, four after ranibizumab injection and seven after bevacizumab injection.

A 2014 survey showed that 88% of the intravitreal procedures in Sweden are carried out in the operating theater and 12% in sterile rooms in an office. Antibiotics are used on the day of injection in 90% of the clinics, while 10% do not give any antibiotics before or after the treatment. Levofloxacin and Fucidin (fusidic acid) are the most frequently used agents.

All 16 endophthalmitis cases received antibiotic prophylaxis and were injected in the operating theater. Draping and blepharostat were used in nine cases, and the InVitria injection assistant device (FCI Ophthalmics) was used in seven cases. – by Michela Cimberle

Disclosure: Westborg reports no relevant financial disclosures.