Table 1 Endophthalmitis following intravitreal anti-VEGF injection—retrospective cases series with at least 10,000 injection
Period and location | Authors | n = injections | Rate of clinically suspected IE | Pre-injection antibiotics | Post injection antibiotics | Mask | Drape | Conjunctival povidone-iodine concentration | Anaesthetic agents used | Sterile lid speculum | Gloves | Location |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 Jan 2009 to 1 Oct 2012 Single-centre, USA | Storey et al. [16] (PIE study group) Ophthal 2013 | 117,171 | Overall 44/117,171 (0.038%; 1/2,663) By Agent Rani: 24/71,791 (0.033%; 1/2,991) Bev: 20/44,007 (0.045%;1/2,200) Aflib: 0/1,373 | Variable | Variable | No* | No | 5% | Drops Subconj (rarely) | Variable | Nil* | Office |
1 Jan 2005 to 31 Dec 2010 Single-centre (multi-site), USA | Moshfeghi et al. [17] Retina 2011 | 60,322 | Overall 12/60,322 (0.020%; 1/5,027) By Agent Rani: 5/18,607 (0.027%; 1/3,721) Bev: 7/39,700 (0.018%; 1/5,671) Peg: 0/2,015 | No | Variable | No* | No | 5% | Drops | Yes | Non-sterile | Office |
1 Jan 2007 to 31 Dec 2011 Single-centre, USA | Chaudhary et al. [18] Retina 2013 | 49,002 | Overall 17/49,002 (0.035%; 1 in 2,882) By Agent Rani: 2/20,297 (0.0099%;1/10,149) Bev: 15/28,705 (0.052%;1/1,914) | Yes | Yes | No | No | 5% | Drops Gel Subconj | Yes | Nil or non-sterile | Office |
2004 to 2012 Multicentre, Switzerland | Casparis et al. [19] Retina 2014 | 40,011 | Overall 3/40,011 (0.0075%;1 in 13,337) By Agent Rani: 3/36,398 (0.0082%, 1/12,133) Bev: 0/3,518 Aflib:0/89 Peg: 0/6 | No | Variable (yes in one hospital, no in the other) | Yes | Yes (adhesive) | 5–10% | Drops | Yes | Sterile | OR |
1 Aug 2006 to 31 Jul 2007 Multi-centre, USA | Klein et al. [20] Ophthal 2009 | 30,736 | Overall 15/30,736 (0.049%; 1/2,049) By Agent Rani: 10/22,579 (0.044%; 1/2,258) Bev: 5/8,039 (0.062%; 1/1,608) Peg: 0/128 | Variable | ? | ? | ? | 5–10% | ? | Variable: used in 14 of the 15 cases with endophthalmitis | ? | Office |
July 2000 to July 2010 Single-centre (multi-site), USA | Chen et al. [21] Retina 2011 | 29,995 | Overall 11/29,995 (0.037%; 1/2,727) By Agent Rani: 8/22,336 (0.036%; 1/2,792) Bev: 3/6,675 (0.045%; 1/2,225) Peg: 0/984 | Yes | Yes | No* | No* | 5–10% | Drops Gel Subconj | Yes | Non-sterile* | Office |
1 Jun 2005 to 7 Aug 2007 Multicentre, USA | Fintak et al. [22] Retina 2008 | 26,905 | Overall 6/26,905 (0.022%; 1/4,484) By Agent Rani: 3/14,320 (0.021%; 1/4,773) Bev: 3/12,585 (0.024%; 1/4,195) | No* | Variable (used in all the cases of endophthalmitis) | No* | No* | 5–10% | Drops Gel Subconj | Variable (used in all the cases of endophthalmitis) Fingers to spread the eyelids in a minority | Nil* | Office |
March 2007 to May 2013 Single-centre, Denmark | Brynskov et al. [23] Retina 2014 | 20,293 | Overall 0/20,293 By Agent Rani: 0/20,024 Aflib: 0/269 | No | Variable | Yes | Yes (adhesive) | 5% | Drops | Yes | Sterile | OR |
1 Aug 1997 to 31 Oct 2012 Single-centre, USA | Bhavsar and Sandler [24] Retina 2015 | 17,666 | Overall 1/17,666 (0.0057%, 1/17,666) By Agent Rani: 0/1,669 Bev: 1/15,479 (0.0065%, 1/15,479) Aflib: 0/148 Peg: 0/370 | No | No | No | No | 5% (before and after injection) | Drops | Yes | Non-sterile | Office |
Jan 2005 to end July 2012 Single-centre, Germany | Nentwich et al. [25] Retina 2014 | 18,202 | Overall 3/18,202 (0.016%; 1/6,067) By Agent Rani: 1/10,097 (0.010%, 1/10,097) Bev: 2/7,865 (0.025%;1/3,932) Peg: 0/240 | No | Yes | Yes | Yes (non-adhesive)* | 1% | Drops | Yes | Sterile | OR |
Jan 2007 to May 2012 Multicentre, India | Mithal et al. [26] BJO 2013 | 15,925 | Overall 8/15,925 (0.050%;1/1,991) By Agent Rani: 1/705 (0.14%; 1/705) Bev: 7/15,035 (0.044%;1/2,275) Peg: 0/185 | No* | Yes* | Yes* | Variable | 2.5%* | Drops* | Yes* | Sterile* | Office* |
July 2009 to July 2012 Single-centre, Japan | Shimada et al. [27] Graefes 2013 | 15,144 | Overall 0/15,144 By Agent Rani: 0/13,750 Bev: 0/846 Peg: 0/548 | Yes | Yes | Yes | Yes (adhesive) | 0.25% (before and after injection) | Drops + Subconj | Yes | Yes | Office |
Jan 2005 to Aug 2010 Multi-centre, Canada | Cheung et al. [28] Ophthal 2012 | 14,960 | Overall 7/14,960 (0.047%; 1/2,137) By Agent Rani: 3/9,453 (0.032%; 1/3,151) Bev: 4/5,386 (0.074%; 1/1,347). Peg: 0/121 | Variable | Variable | No* | No | 10% | Drops Gel | Yes | Nil* | Office |
Mar 2006 to Mar 2012 Multi-centre (single-surgeon), Australia | Abell et al. [29] BJO 2012 | 12,249 | Overall 4/12,249 (0.033%; 1/3,062) By Agent Rani: 3/10,574 (0.028%; 1/3,525)* Bev: 1/1,675 (0.060%; 1/1,675)* | No | Variable (used until 2011)* | Yes | Yes (non-adhesive)* | 10% | Drops + Gel* | Yes | Sterile | Office = 4/3,376 OR = 0/8,873 |
Jan 2009 to Dec 2011 Multi-centre, USA and Italy | Tabandeh et al. [30] Retina 2014 | 11,257 | Overall 5/11,257 By Agent Rani: 3/2,724 (0.11%; 1/908) Bev: 2/8,533 (0.023%; 1/4,267) | Yes in OR No in office | Yes | Yes in OR No in office | Yes in OR No in office | 5% | Drops Subconj | Yes | Sterile in OR Non-sterile in office | Office = 3/8,647 OR = 2/3,063 |
5 Jan 2005 to 18 Oct 2007 Single-centre (multi-site), USA | Pilli et al. [31] AJO 2008 | 10,254 | Overall 2/10,254 (0.020%; 1/5,127) By Agent Rani: 1/6,347 (0.016%; 1/6,347) Bev: 1/3,501 (0.029%; 1/3,501) Peg: 0/406 | No | Yes | No | No | 5% | Drops | Variable | ? “Surgical attire was not used” | Office |
Nov 2010 to Dec 2011 Single-centre, USA | Fineman et al. [32] Retina 2013 | 10,164 | Overall 3/10,164 (0.030%; 1/3,388) By Agent Rani: 1/6,330 (0.016%;1/6,330) Bev: 2/3,834 (0.052%; 1/1,917) | No* | Variable (used until Oct 2,011) | No* | No* | 5% | Drops | No | Nil or non-sterile* | Office* |
1 Jan 2007 to 31 Dec 2011 Single-centre, USA | Englander et al. [33] BJO 2013 | 10,140 | Overall 3/10,140 (0.030%, 1/3,380) By Agent Rani: 3/7,768 (0.039%; 1/2,589) Bev: 0/2,315 Peg: 0/57 | Variable* | Variable | Variable* | Variable | Yes, 5% | Drops Subconj. | Variable | Variable* | Office* |