TY - JOUR
T1 - Endophthalmitis after intravitreal injection
T2 - Role of prophylactic topical ophthalmic antibiotics
AU - Li, Alexa L.
AU - Wykoff, Charles C.
AU - Wang, Rui
AU - Chen, Eric
AU - Benz, Matthew S.
AU - Fish, Richard H.
AU - Wong, Tien P.
AU - Major, James C.
AU - Brown, David M.
AU - Schefler, Amy C.
AU - Kim, Rosa Y.
AU - O'malley, Ronan E.
N1 - Publisher Copyright:
Copyright © by Ophthalmic commnucation society, Inc.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - 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.
AB - 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.
KW - Staphylococcus
KW - Streptococcus
KW - endophthalmitis
KW - postintravitreal injection
KW - prophylaxis
KW - topical ophthalmic antibiotics
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UR - http://www.scopus.com/inward/citedby.url?scp=84949844203&partnerID=8YFLogxK
U2 - 10.1097/IAE.0000000000000901
DO - 10.1097/IAE.0000000000000901
M3 - Article
C2 - 26655622
AN - SCOPUS:84949844203
SN - 0275-004X
VL - 36
SP - 1349
EP - 1356
JO - Retina
JF - Retina
IS - 7
ER -