Incidence of Post-Intravitreal Anti-VEGF Endophthalmitis at Thammasat University Hospital
Navapol Kanchanaranya MD*, Duangmontree Rojdamrongratana MD*, Pratan Piyasoonthorn MD*
Affiliation : * Department of Ophthalmology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Background : Anti-vascular endothelial growth factor (anti-VEGF) drugs have been used as ophthalmic injections to treat
various eye diseases. Recently, the use of this drug has gradually increased as awareness of potential complications,
especially the occurrence of endophthalmitis.
Objective : To report the incidence rate, clinical features, management, and presumed risk factors of acute post-intravitreal
anti-VEGF drug injection endophthalmitis secondary to therapeutic intravitreal ranibizumab and bevacizumab injections.
Material and Method: A retrospective review of all consecutive eyes after intravitreal injections was performed at Thammasat
University Hospital, Pathumthani, from June 2008 to September 2013. Data collected at diagnosis included patient
demographics, intravitreal injection details, pre- and post-injection management, visual acuity, clinical features and
managements, causative organisms, and clinical outcomes.
Results : During the 5-year-study interval, 1,169 intravitreal injections were performed. The overall incidence rate of
endophthalmitis was 0.17% (2 of 1,169 injections). In our series, the endophthalmitis occurred after the 1st and 2nd injection.
Bacterial cultures and gram stain revealed coagulase-negative Staphylococcus species (n = 1) and no organism found
(n = 1). All cases were treated efficiently in limiting the devastating sequels by intravitreal antibiotics, steroids and pars plana
vitrectomy. The result showed that recovery of useful vision was found in one case and devastating vision in another case.
Conclusion : Acute endophthalmitis is a rare potential complication after intravitreal injection. Prognosis of endophthalmitis
varies widely depending upon the severity of the infection, the organism involved and the amount of damage the eye sustains
from inflammation and scarring. Further studies are required to clarify the best prophylactic techniques to prevent this rare
complication.
Keywords : Endophthalmitis, Anti-VEGF drug, Intravitreal injection, Ranibizumab, Bevacizumab
