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Kim, Lee, Kang, Lew, Choi, Han, You, Cho, Lee, and Lee: Incidence and Characteristics of Acute Endophthalmitis Associated With Intravitreal Injection
Original Article

J Korean Ophthalmol Soc 2009;50(7):1060-1065.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.7.1060

Incidence and Characteristics of Acute Endophthalmitis Associated With Intravitreal Injection

Hyun Jin Kim, MD1, Dong Won Lee, MD2, Hyo Jung Kang, MD3, Young Ju Lew, MD2, Moon Jeong Choi, MD2, Jung Il Han, MD2, Su Jin You, MD2, Sung Won Cho, MD2, Tae Gon Lee, MD3, Jae Heung Lee, MD2

1Department of Ophthalmology, School of Medicine, Ewha Woman's University, Seoul, Korea

2Myung Gok Eye Research Institute, Kim's Eye Hospital, Konyang University, Seoul, Korea

3Department of Ophthalmology, Konyang University College of Medicine, Seoul, Korea

Address reprint requests to Dong Won Lee, MD Myung Gok Eye Research Institute, Kim's Eye Hospital, Konyang University #156 Yeoungdeungpo-dong, 4ga, Yeoungdeungpo-gu, Seoul 150-034, Korea Tel: 82-2-2639-7811, Fax: 82-2-2633-3976, E-mail: mediceye@kimeye.com

Received 3 December 2008       Accepted 23 April 2009

Copyright © 2009 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the incidence, causative organism, clinical features, and visual outcomes of acute endophthalmitis following intravitreal injection.

Methods

For all intravitreal triamcinolone acetonide, bevacizumab, and lucentis injections performed in our outpatient clinic between January 2006 and June 2008, the number of injections, indications, type of administered drugs, and method of injection were investigated. The medical records of the patients with acute endoththalmitis were reviewed retrospectively.

Results

The total number of intravitreal injections was 10,153. The incidence of acute endophthalmitis for all intravitreal injections was 0.020% (2/10,153) with 0.030% (1/3,383) for the triamcinolone acetonide, 0.015% (1/6,552) for the bevacizumab, and 0.000% (0/218) for the ranibizumab drug injections. Streptococcus species were confirmed in the bacterial culture of two eyes with acute endotphthalmitis. After early vitrectomy and intravitreal antibiotics injection, one eye maintained vision but the other eye developed phthisis.

Conclusions

Although the incidence of acute endophthalmitis following intravitreal injections performed in outpatient clinics is very low, due to the potentially fatal visual outcome after endophthalmitis, careful attention to aseptic injection technique is mandatory.

Keywords: Anti-VEGF, Endophthalmitis

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Figure 1.
Fundus photograph, one month after vitrectomy.
jkos-50-1060f1.tif
Figure 2.
Slit lamp photograph (left) and ultrasonogram (right) obtained 4 days after intravitreal triamcinolone acetonide injection.
jkos-50-1060f2.tif
Table 1.
Patient demographics
IVTA* Avastin Lucentis
M:F 1819: 1564 3720: 2832 119: 99
Age 58.1± 13.2 59.3±13.2 59.8± 13.6
OD†:OS‡ 1760: 1623 3430: 3122 103: 115
DMR§ 1835 2818 0
CNV∏ 417 2330 207
BRVO＃ 640 615 0
CRVO** 339 486 0
Disease CSC†† 6 125 3
PCV‡‡ 3 64 5
RAP§§ 1 1 3
Others 142 113 0
Total 3383 6552 218

* IVTA=intravitreal trimacinolone injection

† OD=right side

‡ OS=left side

§ DMR=diabetic retinopathy

∏ CNV=choroidal neovascularization

＃ BRVO=branchretinal vein occlusion

** CRVO=central retinal vein occlusion

†† CSC=central serous chorioretinopathy

‡‡ PCV=polypoidal choroidal vasculopathy

§§ RAP=retinal angiomatous proliferation

Table 2.
Number of injections and incidence of endophthalmitis
Number Endophthalmitis
Triancinolone acetonide (4∼8 mg/0.1 cc) 3,383 1 (0.030%)
Bevacizumab (1.25 mg/0.05 cc) 6,552 1 (0.015%)
Ranibizumab (0.3∼0.5 mg/0.05 cc) 218 0 (0%)
Total injection 10,153 2 (0.020%)
Table 3.
Incidence of endophthalmitis associated with anti-VEGF
Study name Incidence of endophthalmitis
VISION study 0.16%
MARINA study 0.05%
ANCHOR study 0.13%
Kim's Eye Hospital 0.015%
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