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Table 1 Endophthalmitis following intravitreal anti-VEGF injection—retrospective cases series with at least 10,000 injection

From: Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review

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*
  1. Steroid and other injections have been excluded.
  2. Anesthetic: “Drops” refers to drops given alone or with the aid of a cotton bud or pledget.
  3. Location: “office-based” includes studies where the injections were performed in a clean procedure room, or in the consulting room itself, within an office or outpatients department.
  4. Rani ranibizumab, Bev bevacizumab, Aflib aflibercept and Peg pegaptanib.
  5. * These points were not explicitly mentioned in the manuscript, but were clarified through personal communication with the corresponding author of the paper.
  6. ? These points were not mentioned in the manuscript, and the corresponding authors could not be contacted.