Endophthalmitis After Intravitreal Injection

In Brief Purpose: To report the incidence, clinical features, microbiologic culture results, management and visual outcome of patients with endophthalmitis after intravitreal injections (IVTs). Methods: This retrospective chart review included all patients receiving IVTs between January 2005 and July 2012. Cases of suspected and confirmed endophthalmitis after IVT were identified and reviewed. Results: A total of 20,179 IVTs were perfomed during the study period. Six cases of supected endophthalmitis were identified clinically (0.03%), of which 3 were culture positive (0.015%). The risk of culture-positive post-IVT endophthalmitis was 2/8,882 (0.023%) in the 2005 to 2008 period and 1/11,297 (0.009%) in the period 2009 to 2012. Symptoms developed within the first 3 days after IVT in 4 of the 6 patients and visual acuity was reduced to hand motion in 4 of the 6 patients. Microbiologic specimens were positive on 3 of the 6 cases (coagulase-negative Staphylococcus, n = 2; Staphylococcus aureus, n = 1). Mean visual acuity before patients with endophthalmitis was 20/100, whereas mean final visual acuity at last follow-up was 20/200. Conclusion: The incidence of endophthalmitis after IVT was low with no cases because of Streptococcus species in the present setting using povidone-iodine in the preoperative disinfection of the conjunctival sac. Therefore, adherence to standardized protocols including the use of povidone-iodine when performing IVTs is recommended. In a series of 20,179 intravitreal injections, the incidence of postinjection endophthalmitis was low and even declined during the study period. No cases because of Streptococcus species occurred in the present setting, where povidone-iodine was used in the preoperative disinfection of the conjunctival sac.