Global reported endophthalmitis risk following intravitreal injections of anti-VEGF: A literature review and analysis

Douglas K. Sigford, Shivani Reddy, Christine Mollineaux, Shlomit Schaal

Research output: Contribution to journalArticlepeer-review

61 Scopus citations


Purpose: To report on endophthalmitis occurrence and associated risk factors following the intravitreal injection of anti-VEGF agents based on a review of published literature.Materials and methods: A Medline search was performed using the terms “bevacizumab” and “ranibizumab”. A total of 534 English-language articles of varying design and published from 2006 to November 2013 were analyzed for endophthalmitis occurrence and contributing perioperative factors. Results: A total of 445,503 injections were counted. There were 103 cases of postinjection endophthalmitis in 176,124 injections (0.058%) with bevacizumab (Avastin) versus 79 cases in 269,379 injections (0.029%) with ranibizumab (Lucentis). This difference was due to a significantly higher occurrence of culture-negative endophthalmitis associated with bevacizumab injections. Culture-positive risk was not statistically different between the two drugs. The reported use of postinjection topical antibiotics increased the risk of culture-positive endophthalmitis. No association was found with the use of povidone iodine, a lid speculum, a mask, or an operating room. Streptococcus spp. were the most prevalent causative organism, accounting for nine of 54 (17%) of all culture-positive cases. Conclusion: Reported postinjection endophthalmitis occurred significantly more in patients treated with bevacizumab than those treated with ranibizumab. However, culture-positive occurrence was similar. Despite the potential for contamination at the time of drug compounding, bevacizumab does not appear to confer a higher risk of culture-positive endophthalmitis than ranibizumab. This study also suggests antibiotic use may increase endophthalmitis occurrence.

Original languageEnglish (US)
Pages (from-to)773-781
Number of pages9
JournalClinical Ophthalmology
StatePublished - May 2 2015


  • Endophthalmitis
  • Eye infections
  • Intravitreal injections
  • Panophthalmitis

ASJC Scopus subject areas

  • Ophthalmology


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