TY - JOUR
T1 - Predictors of Endophthalmitis after Intravitreal Injection
T2 - A Multivariable Analysis Based on Injection Protocol and Povidone Iodine Strength
AU - Stem, Maxwell S.
AU - Rao, Prethy
AU - Lee, Ivan J.
AU - Woodward, Maria A.
AU - Faia, Lisa J.
AU - Wolfe, Jeremy D.
AU - Capone, Antonio
AU - Covert, Douglas
AU - Dass, A. Bawa
AU - Drenser, Kimberly A.
AU - Garretson, Bruce R.
AU - Hassan, Tarek S.
AU - Margherio, Alan
AU - Oh, Kean T.
AU - Raephaelian, Paul V.
AU - Randhawa, Sandeep
AU - Sneed, Scott
AU - Trese, Michael T.
AU - Yedavally, Sunita
AU - Williams, George A.
AU - Ruby, Alan J.
N1 - Funding Information:
Supported by the National Eye Institute, National Institutes of Health, Bethesda, Maryland (grant no.: EY0235096 [M.A.W.]).
Publisher Copyright:
© 2018 American Academy of Ophthalmology
PY - 2019/1
Y1 - 2019/1
N2 - Purpose: To determine the incidence of endophthalmitis after anti–vascular endothelial growth factor (VEGF) therapy at our institution and to identify potential risk factors for endophthalmitis occurring after injection. Design: Retrospective, single-center cohort study. Participants: All patients who received an intravitreal injection of an anti-VEGF medication between January 1, 2014, and March 31, 2017. Methods: Current Procedural Terminology and International Classification of Diseases billing codes were used to identify instances of anti-VEGF administration and cases of endophthalmitis. Medical records and injection technique were reviewed carefully in each case. Multivariable logistic regression analysis was performed in a stepwise fashion to determine independent predictors of endophthalmitis based on injection protocol. Main Outcome Measures: Incidence of endophthalmitis after injection and odds of endophthalmitis by injection technique with 95% confidence intervals (CIs). Results: A total of 154 198 anti-VEGF injections were performed during the period of interest, resulting in 58 cases of endophthalmitis (0.038% [1:2659]). After adjustment for confounders, both 2% lidocaine jelly (odds ratio [OR], 11.28; 95% CI, 3.39–37.46; P < 0.001) and 0.5% Tetravisc (Ocusoft, Richmond, TX; OR, 3.95; 95% CI, 1.15–13.50; P = 0.03) use were independent risk factors for endophthalmitis after injection. Lid speculum use, povidone iodine strength (5% vs. 10%), injection location (superior or inferior), conjunctival displacement, use of provider gloves, use of a strict no-talking policy, use of subconjunctival lidocaine, and topical antibiotic use were not statistically significant predictors of endophthalmitis after injection. There was no difference in endophthalmitis rate among the anti-VEGF agents (bevacizumab, ranibizumab 0.3 mg, ranibizumab 0.5 mg, and aflibercept). Conclusions: The incidence of endophthalmitis after anti-VEGF injections is low. Use of lidocaine jelly or Tetravisc may increase the risk of endophthalmitis after injection.
AB - Purpose: To determine the incidence of endophthalmitis after anti–vascular endothelial growth factor (VEGF) therapy at our institution and to identify potential risk factors for endophthalmitis occurring after injection. Design: Retrospective, single-center cohort study. Participants: All patients who received an intravitreal injection of an anti-VEGF medication between January 1, 2014, and March 31, 2017. Methods: Current Procedural Terminology and International Classification of Diseases billing codes were used to identify instances of anti-VEGF administration and cases of endophthalmitis. Medical records and injection technique were reviewed carefully in each case. Multivariable logistic regression analysis was performed in a stepwise fashion to determine independent predictors of endophthalmitis based on injection protocol. Main Outcome Measures: Incidence of endophthalmitis after injection and odds of endophthalmitis by injection technique with 95% confidence intervals (CIs). Results: A total of 154 198 anti-VEGF injections were performed during the period of interest, resulting in 58 cases of endophthalmitis (0.038% [1:2659]). After adjustment for confounders, both 2% lidocaine jelly (odds ratio [OR], 11.28; 95% CI, 3.39–37.46; P < 0.001) and 0.5% Tetravisc (Ocusoft, Richmond, TX; OR, 3.95; 95% CI, 1.15–13.50; P = 0.03) use were independent risk factors for endophthalmitis after injection. Lid speculum use, povidone iodine strength (5% vs. 10%), injection location (superior or inferior), conjunctival displacement, use of provider gloves, use of a strict no-talking policy, use of subconjunctival lidocaine, and topical antibiotic use were not statistically significant predictors of endophthalmitis after injection. There was no difference in endophthalmitis rate among the anti-VEGF agents (bevacizumab, ranibizumab 0.3 mg, ranibizumab 0.5 mg, and aflibercept). Conclusions: The incidence of endophthalmitis after anti-VEGF injections is low. Use of lidocaine jelly or Tetravisc may increase the risk of endophthalmitis after injection.
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U2 - 10.1016/j.oret.2018.09.013
DO - 10.1016/j.oret.2018.09.013
M3 - Article
AN - SCOPUS:85069815994
SN - 2468-6530
VL - 3
SP - 3
EP - 7
JO - Ophthalmology Retina
JF - Ophthalmology Retina
IS - 1
ER -