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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.