Study investigates rates, risk factors, outcomes of post-injection endophthalmitis
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SEATTLE — A study based on IRIS Registry data delved into the rates, risk factors, management strategies and outcomes of post-intravitreal anti-VEGF injection endophthalmitis.
“The AAO’s IRIS Registry is the world’s largest subspecialty clinical database at this time. Established in 2014, there are over 440 million unique patient visits. Nearly three-quarters of practicing ophthalmologists in the United States currently participate,” Alia K. Durrani, MD, said at the American Society of Retina Specialists annual meeting.
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Of the 20.1 million injections reported in the registry, 6,109 injections of 6,109 eyes of 6,082 patients were included in the study, for an overall endophthalmitis incidence of 0.0286%. Among them, there were 738 eyes of 711 patients who underwent bilateral injections. Aflibercept was used for the majority of injections, followed by bevacizumab and ranibizumab.
Bilateral post-intravitreal injection endophthalmitis (PIE) was reported in 27 patients. Mean visual acuity was 20/59 before endophthalmitis, 20/98 at 6 months and 20/87 at 1 year. The mean number of days to diagnosis was 4, and the mean number of injections before endophthalmitis was 12.7.
“We found that prior or active smokers had increased odds of developing endophthalmitis. Bilateral same-day injections did not confer higher odds for development of PIE. Region, race, diagnosis, drug and insurance carrier did not confer significantly higher odds of developing PIE,” Durrani said.
Management of PIE with early vitrectomy did not demonstrate clear visual acuity benefits. Compared with management with intravitreal injections of antibiotics alone, at 1 year, eyes that underwent vitrectomy had an associated loss of approximately two lines from baseline.
In contrast, early management was found to be key for preserving vision.
“Each day between initial injection of anti-VEGF agent and diagnosis of PIE was associated with decreased acuity of approximately one Snellen letter,” Durrani said.
Insurance product, race, gender and region were not associated with visual acuity outcomes.
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Durrani AK, et al. Rates of post-intravitreal anti-VEGF injection endophthalmitis, management strategies, and visual acuity outcomes from the AAO IRIS Registry. Presented at: American Society of Retina Specialists annual meeting; July 28-Aug. 1, 2023; Seattle.
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