Incidence of Endophthalmitis after Intravitreal Anti-vascular Endothelial Growth Factor: Experience in Saudi Arabia.
PURPOSE
To report the incidence of endophthalmitis, the clinical and microbiological aspects, after intravitreal (IVT) injection of anti-vascular endothelial growth factor.


METHODS
A chart review was performed of patients diagnosed with endophthalmitis after receiving IVT injections of bevacizumab (Avastin) and ranibizumab (Lucentis) presenting to King Khaled Eye Specialist Hospital (KKESH) from May 2006 to December 2012. Endophthalmitis was diagnosed clinically as an intraocular infection with vitreous involvement that required treatment with IVT antibiotics or had undergone pars plana vitrectomy (PPV) to remove the suspected microorganism. Main outcome measures were the incidence of endophthalmitis and the clinical and microbiological features.


RESULTS
Seven cases of endophthalmitis were identified, there was 1 (0.004%) case of endophthalmitis of 22674 IVT injections performed at KKESH. All cases were after IVT bevacizumab. Three (42.85%) cases were culture-positive and caused by Staphylococcus epidermidis. The initial management was vitreous tap and IVT injection of antibiotics followed by PPV in 6 (85.7%) cases. One (14.3%) case underwent evisceration. Visual acuity improved at last visit in only 2 (28.6%) cases. The rate of endophthalmitis was 0.0004% for bevacizumab.


CONCLUSIONS
The rate of endophthalmitis after IVT bevacizumab and ranibizumab was very low. We recommend following a standardized injection protocol, adherence to sterile techniques, and proper patient follow-up are determinant factors for low incidence rates. In addition, endophthalmitis after IVT bevacizumab and ranibizumab have poor visual outcomes despite prompt treatment.
['Al-Rashaed|Saba|S|', 'Alsulaiman|Sulaiman M|SM|', 'Alrushood|Abdulaziz Adel|AA|', 'Almasaud|Jluwi|J|', 'Arevalo|J Fernando|JF|']
D000368:Aged D020533:Angiogenesis Inhibitors D000900:Anti-Bacterial Agents D000068258:Bevacizumab D002442:Ceftazidime D004359:Drug Therapy, Combination D009877:Endophthalmitis D015818:Eye Infections, Bacterial D005260:Female D006801:Humans D015994:Incidence D058449:Intravitreal Injections D008297:Male D008875:Middle Aged D000069579:Ranibizumab D012189:Retrospective Studies D012529:Saudi Arabia D013203:Staphylococcal Infections D013212:Staphylococcus epidermidis D014640:Vancomycin D042461:Vascular Endothelial Growth Factor A
Endophthalmitis Anti-vascular Endothelial Growth Factor Saudi Arabia Bevacizumab Ranibizumab Gulf States Intravitreal Injection