This large retrospective chart review assessed the rate of endophthalmitis after bilateral same-day intravitreal anti-VEGF injections.

Study design

Investigators reviewed the charts of 5,890 patients with neovascular AMD, diabetic macular edema, or retinal vein occlusions who received their first injection between 2012 and 2017. The study included a total of 101,932 bilateral same-day intravitreal anti-VEGF injections—55,051 ranibizumab, 32,542 aflibercept, and 14,339 bevacizumab. Charts were reviewed to identify indications for injections and post-injection complications.

Outcomes

Injections were administered most often for neovascular AMD (54.3%) and diabetic macular edema (35.4%).

There were 28 cases of unilateral endophthalmitis (0.027%) identified; 5 were after bevacizumab, 10 after ranibizumab, and 13 after aflibercept injection. However, none of the patients had more than 1 case of endophthalmitis and there were no bilateral cases. Neither diagnosis nor anti-VEGF agent significantly altered infection rates.

Limitations

This study relied on a coding search to identify both injections and cases of endophthalmitis. The injection techniques and preferences used by treating physicians were heterogenous, with the majority of patients in this study receiving ranibizumab; however, the majority of anti-VEGF injections in the US are bevacizumab.

Clinical significance

This study suggests that bilateral same-day intravitreal injection of anti-VEGF medication appears safe and confers no increased risk of infection or complications to patients.