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* |
Steroid and other injections have been excluded.
Anesthetic: “Drops” refers to drops given alone or with the aid of a cotton bud or pledget.
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.
Rani ranibizumab, Bev bevacizumab, Aflib aflibercept and Peg pegaptanib.
* These points were not explicitly mentioned in the manuscript, but were clarified through personal communication with the corresponding author of the paper.
? These points were not mentioned in the manuscript, and the corresponding authors could not be contacted.