Infectious Complications of Intravitreal AntiVEGF Therapy of the Wet Form of Age-Related Macular Degeneration
Abstract
To determine the incidence of endophthalmitis following intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents and to evaluate result of surgical terapy. DESIGN: A retrospective study.
METHODS: A total of 2,274 intravitreal anti-VEGF injections (1,213 pegaptanib, 1,061 ranibizumab) were performed from 2007 to 2010. The injections were performed as an out-patient procedure with use of povidone-iodine as a part of preinjection preparation.
Preinjection topical antibiotics, sterile enviroment, sterile gloves and postinjection topical antibiotics were used. RESULTS: There were eigth cases of endophthalmitis, six cases following pegaptanib injection and two cases following ranibizumab injection.
Only one patient regained her pre-injection visual acuity. The incidence of endophthalmitis was 0,35%.
There was no difference in the incidence of endophthalmitis between pegaptanib and ranibizumab (P = 0.6). CONCLUSIONS: Although there is no consensus regarding the intravitreal injection procedure technique, the incidence of endophthalmitis was low in a large series of injected patients in a comparision with results reported in clinical trials where much more extensive preinjection preparation was mandated.
The most frequent pathogen was found Streptococcus epidermidis (75% cases). We found no difference in the endophthalmitis risk of patients receiving pegaptanib as compared with ranibizumab.
Cultivation of infectious pathogenes from the sample of vitreous is an integral part in the management of the endophthalmitis and essential for antibiotic policy of an applications center.