Nadim Rayess1, Ehsan Rahimy1, Philip Storey1, Chirag P Shah2, Jeremy D Wolfe3, Eric Chen4, Francis Char DeCroos5, Sunir J Garg1, Jason Hsu6. 1. Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania. 2. Ophthalmic Consultants of Boston, Boston, Massachusetts. 3. Associated Retinal Consultants at William Beaumont Hospital, Royal Oak, Michigan. 4. Retina Consultants of Houston, Houston, Texas. 5. Southeastern Retina Associates, Chattanooga, Tennessee. 6. Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania. Electronic address: jhsu@midatlanticretina.com.
Abstract
PURPOSE: To compare the incidence and clinical outcomes of endophthalmitis following intravitreal injections of bevacizumab, ranibizumab, and aflibercept. DESIGN: Multicenter, retrospective cohort study. METHODS: All included patients had received intravitreal injections of bevacizumab, ranibizumab, or aflibercept between January 1, 2009 and September 30, 2013 at 5 retina practices. Billing records were used to identify the total number of anti-vascular endothelial growth factor (VEGF) injections administered. Patients who developed endophthalmitis were ascertained from endophthalmitis logs and billing records. Chart review of these patients was performed to confirm that the endophthalmitis was related to the antecedent anti-VEGF injection. Visual outcomes, causative organisms, and clinical course were also recorded. RESULTS: A total of 503 890 anti-VEGF injections were included, from which 183 cases of presumed endophthalmitis were identified. The rate of endophthalmitis for bevacizumab was 0.039% (60/153 812), which was similar to ranibizumab 0.035% (109/309 722; P = .522) and aflibercept 0.035% (14/40 356; P = .693). Similarly, there was no difference in the rates between ranibizumab and aflibercept (P = .960). The culture-positive rate of the vitreous/aqueous tap was 38% for both bevacizumab and ranibizumab and was 43% for aflibercept. Furthermore, visual acuity remained decreased at 3 months follow-up for bevacizumab (P = .005), ranibizumab (P < .001), and aflibercept (P = .07) compared to vision at causative injection. CONCLUSIONS: Endophthalmitis following intravitreal bevacizumab, ranibizumab, and aflibercept injection appears to occur at similar rates and have comparable visual outcomes. This study suggests that the choice of anti-VEGF agent should be primarily based on efficacy and patient response rather than concern for risk of infection.
PURPOSE: To compare the incidence and clinical outcomes of endophthalmitis following intravitreal injections of bevacizumab, ranibizumab, and aflibercept. DESIGN: Multicenter, retrospective cohort study. METHODS: All included patients had received intravitreal injections of bevacizumab, ranibizumab, or aflibercept between January 1, 2009 and September 30, 2013 at 5 retina practices. Billing records were used to identify the total number of anti-vascular endothelial growth factor (VEGF) injections administered. Patients who developed endophthalmitis were ascertained from endophthalmitis logs and billing records. Chart review of these patients was performed to confirm that the endophthalmitis was related to the antecedent anti-VEGF injection. Visual outcomes, causative organisms, and clinical course were also recorded. RESULTS: A total of 503 890 anti-VEGF injections were included, from which 183 cases of presumed endophthalmitis were identified. The rate of endophthalmitis for bevacizumab was 0.039% (60/153 812), which was similar to ranibizumab 0.035% (109/309 722; P = .522) and aflibercept 0.035% (14/40 356; P = .693). Similarly, there was no difference in the rates between ranibizumab and aflibercept (P = .960). The culture-positive rate of the vitreous/aqueous tap was 38% for both bevacizumab and ranibizumab and was 43% for aflibercept. Furthermore, visual acuity remained decreased at 3 months follow-up for bevacizumab (P = .005), ranibizumab (P < .001), and aflibercept (P = .07) compared to vision at causative injection. CONCLUSIONS:Endophthalmitis following intravitreal bevacizumab, ranibizumab, and aflibercept injection appears to occur at similar rates and have comparable visual outcomes. This study suggests that the choice of anti-VEGF agent should be primarily based on efficacy and patient response rather than concern for risk of infection.
Authors: Joseph M Simonett; Austin Igelman; Stanford C Taylor; J Peter Campbell; Thomas S Hwang; Phoebe Lin; Andreas K Lauer; Christina J Flaxel Journal: Ophthalmic Surg Lasers Imaging Retina Date: 2019-01-01 Impact factor: 1.300
Authors: Philip Hykin; A Toby Prevost; Sobha Sivaprasad; Joana C Vasconcelos; Caroline Murphy; Joanna Kelly; Jayashree Ramu; Abualbishr Alshreef; Laura Flight; Rebekah Pennington; Barry Hounsome; Ellen Lever; Andrew Metry; Edith Poku; Yit Yang; Simon P Harding; Andrew Lotery; Usha Chakravarthy; John Brazier Journal: Health Technol Assess Date: 2021-06 Impact factor: 4.014
Authors: Gary Gensler; Traci E Clemons; Amitha Domalpally; Ronald P Danis; Barbara Blodi; Jack Wells; Michael Rauser; John Hoskins; G Baker Hubbard; Michael J Elman; Gary E Fish; Alexander Brucker; Alan Margherio; Emily Y Chew Journal: Ophthalmol Retina Date: 2018-05