ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTION: Role of Prophylactic Topical Ophthalmic Antibiotics. Issue 7 (July 2016)

• Record Type: Journal Article
• Authors: Li, Alexa L.; Wykoff, Charles C.; Wang, Rui; Chen, Eric; Benz, Matthew S.; Fish, Richard H.; Wong, Tien P.; Major, James C.; Brown, David M.; Schefler, Amy C.; Kim, Rosa Y.; O'Malley, Ronan E.
• Is Part Of: Retina. Volume 36:Issue 7(2016:Jul.)
• Publication Date: 2016-07
• Subjects: endophthalmitis -- postintravitreal injection -- prophylaxis -- Staphylococcus -- Streptococcus -- topical ophthalmic antibiotics; Retina -- Diseases -- Periodicals; Retinal Diseases; Vitreous Body; 617.735
• DOI: 10.1097/IAE.0000000000000901
• Languages: English
• ISSNs: 0275-004X

Abstract

Abstract : Purpose: To determine the rate of postintravitreal injection endophthalmitis and to assess microbiological features and outcomes with and without the use of peri-intravitreal injection topical ophthalmic antibiotics. Methods: Consecutive series of endophthalmitis cases retrospectively identified after intravitreal injection at a multicenter, retina-only referral practice (Retina Consultants of Houston) from January 1, 2011 to December 31, 2014. Prophylactic peri-intravitreal injection topical antibiotics were routinely used during the initial 12-month period (January 1, 2011–December 31, 2011) and not used in the final 24-month period (January 1, 2013–December 31, 2014). Main outcome measures were incidence of endophthalmitis, microbiology results, treatment strategies, and visual outcomes. Results: Of 90, 339 intravitreal injections, 30 cases of endophthalmitis were identified (endophthalmitis rate = 0.033%; 95% confidence interval, 0.021–0.045%; or approximately 1 of 3, 011 intravitreal injections). The most common organisms isolated were coagulase-negative staphylococci (n = 10, 33%), followed by Streptococcus mitis (n = 2, 7%). Fourteen cases (47%) were culture negative. Peri-intravitreal injection topical antibiotic prophylaxis did not decrease the rate of endophthalmitis (0.035% [95% CI, 0.007–0.064%] with antibiotic use versus 0.021% [95% CI, 0.008–0.033%] without antibiotic use; P = 0.261). Conclusion: The risk of endophthalmitis after intravitreal injection remains low, with coagulase-negative staphylococci and Streptococcus mitis the most common bacterial isolates identified. Prophylactic peri-intravitreal injection topical ophthalmic antibiotic use did not decrease the endophthalmitis rate. Abstract : In this consecutive case series of 90, 339 intravitreal injections from a large, office-based retina practice, the rate of postinjection clinically suspected endophthalmitis was 0.033%, and the most common microbiological isolates were staphylococcal and streptococcal species. Prophylactic peri-intravitreal injection topical ophthalmic antibiotic use did not affect the rate of endophthalmitis.