Endophthalmitis following intravitreal injections at a tertiary center: real-life data on incidence, risk factors, management strategies, and visual outcomes

Abstract

Abstract Purpose To investigate the incidence, contributing factors, management, and long-term outcomes of endophthalmitis following intravitreal injections performed in our clinic. Methods This retrospective study included all patients who received intravitreal bevacizumab, aflibercept, ranibizumab, or dexamethasone injections between 2019 and 2024 at four retina clinics of Ankara Bilkent City Hospital. Demographic characteristics of the patients, visual acuity, intravitreal injection etiology, comorbidities, and treatments applied were recorded. Patients who received antibiotic prophylaxis after intravitreal injections (IVI) were categorized as Group 1, while those who did not receive prophylaxis were classified as Group 2. Results A total of 4171 patients and 21,339 intravitreal injections were evaluated. Of the participants, 47.2% were female and 52.8% were male, with a mean age of 66.3 ± 10.3 years (range: 40–98). Group 1 included 13,121 injections (61%), while Group 2 had 8,218 injections (39%). Endophthalmitis was observed in 13 patients (3.0 per 1000 patients—8.1 per 10,000 injections). Patients who developed endophthalmitis had an average of 6.1 ± 4.1 prior injections (range: 2–16), and the mean time to presentation after the last injection was 7.6 ± 3.4 days (range: 2–14). Endophthalmitis cases were distributed as 7 in Group 1 (5.3 per 10,000) and 6 in Group 2 (4.4 per 10,000). The endophthalmitis rate in Group 1 was not statistically significantly different from Group 2 (p > 0.05). All patients received vitreous taps and intravitreal vancomycin-ceftazidime injections at initial presentation. Eleven patients (85%) underwent a pars plana vitrectomy within 24 h. The mean follow-up period was 32 ± 20 months, and any case did not require evisceration surgery. Conclusion Early surgical intervention in cases of endophthalmitis is the most critical approach for preserving the eye and achieving visual rehabilitation. Notably, endophthalmitis was more common in people who got intravitreal bevacizumab or dexamethasone injections, and antibiotic prophylaxis did not appear to reduce the risk of its occurrence.

Keywords

• Intravitreal injection
• Endophthalmitis
• Bevacizumab
• Ranibizumab
• Aflibercept
• Dexamethasone