Incidence of endophthalmitis after intravitreal injection of an anti-VEGF agent with or without topical antibiotics

• Published in: Scientific reports Vol. 10; no. 1; p. 22122
• Main Authors: Morioka, Masakazu, Takamura, Yoshihiro, Nagai, Kazuki, Yoshida, Shigeo, Mori, Junya, Takeuchi, Masaru, Sawada, Tomoko, Sone, Kumiko, Fukuyama, Hisashi, Kusuhara, Sentaro, Yasukawa, Tsutomu, Murakami, Tomoya, Tabuchi, Hitoshi, Nagasato, Daisuke, Hirano, Takao, Ueda, Tetsuo, Jujo, Tatsuya, Sasajima, Hirofumi, Mitamura, Yoshinori, Ishikawa, Kunihiro, Inatani, Masaru
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 17.12.2020; Nature Publishing Group; Nature Portfolio
• Subjects: 692/699/255/1318; 692/699/3161/3175; Angiogenesis Inhibitors - administration & dosage; Angiogenesis Inhibitors - adverse effects; Anti-Bacterial Agents - administration & dosage; Antibiotic Prophylaxis; Antibiotics; Endophthalmitis; Endophthalmitis - drug therapy; Endophthalmitis - epidemiology; Endophthalmitis - etiology; Eye; Gloves; Humanities and Social Sciences; Humans; Incidence; Injection; Intravitreal Injections; multidisciplinary; Prophylaxis; Public Health Surveillance; Retinal Diseases - complications; Retinal Diseases - drug therapy; Science; Science (multidisciplinary); Statistical analysis; Surveys and Questionnaires; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - antagonists & inhibitors
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-79377-w

Intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) is the standard treatment modality in various types of retinal diseases. However, endophthalmitis remains the most serious complication. Despite the lack of evidence that antibiotics prevent endophthalmitis, topical antibiotics are still used routinely in Japan. We conducted a retrospective multicenter study by analyzing records from patients who underwent IVI of anti-VEGF agents with or without antibiotic treatment. In the analysis of a total of 147,440 eyes, the incidence of endophthalmitis was 0.007%: 0.005% with no use of antibiotics, 0.009% with antibiotic pretreatment, 0.012% with posttreatment, and 0.005% with pre- and posttreatment. There was no statistically significant difference among the four groups (chi-square test, p  = 0.57). Most facilities used masks, sterilized gloves, and drapes. Nine of the 10 eyes that developed endophthalmitis received topical antibiotics, and all infected eyes underwent IVI with aflibercept, not the prefilled syringe delivery system. In four patients who received multiple IVI, the detection of causative bacteria revealed resistance to used antibiotics. Data from this large population, treated with or without antibiotics, suggests that antibiotic prophylaxis does not reduce the rate of endophthalmitis after IVI.