Predictors of Endophthalmitis after Intravitreal Injection: A Multivariable Analysis Based on Injection Protocol and Povidone Iodine Strength

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. Retrospective, single-center cohort study. All patients who received an intravitreal inj...

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Bibliographic Details
Published in:	Ophthalmology retina Vol. 3; no. 1; p. 3
Main Authors:	Stem, Maxwell S, Rao, Prethy, Lee, Ivan J, Woodward, Maria A, Faia, Lisa J, Wolfe, Jeremy D, Capone, Jr, Antonio, Covert, Douglas, Dass, A Bawa, Drenser, Kimberly A, Garretson, Bruce R, Hassan, Tarek S, Margherio, Alan, Oh, Kean T, Raephaelian, Paul V, Randhawa, Sandeep, Sneed, Scott, Trese, Michael T, Yedavally, Sunita, Williams, George A, Ruby, Alan J
Format:	Journal Article
Language:	English
Published:	United States 01-01-2019
Subjects:	Adult Angiogenesis Inhibitors - administration & dosage Bevacizumab - administration & dosage Endophthalmitis - diagnosis Endophthalmitis - epidemiology Endophthalmitis - microbiology Eye Infections, Bacterial - diagnosis Eye Infections, Bacterial - epidemiology Eye Infections, Bacterial - microbiology Female Humans Incidence Intravitreal Injections - adverse effects Male Middle Aged Povidone-Iodine - administration & dosage Ranibizumab - administration & dosage Retinal Diseases - drug therapy Retrospective Studies Risk Factors Vascular Endothelial Growth Factor A - antagonists & inhibitors
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Summary:	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. Retrospective, single-center cohort study. All patients who received an intravitreal injection of an anti-VEGF medication between January 1, 2014, and March 31, 2017. 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. Incidence of endophthalmitis after injection and odds of endophthalmitis by injection technique with 95% confidence intervals (CIs). 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). The incidence of endophthalmitis after anti-VEGF injections is low. Use of lidocaine jelly or Tetravisc may increase the risk of endophthalmitis after injection.
ISSN:	2468-7219
DOI:	10.1016/j.oret.2018.09.013