Comparative Endophthalmitis Rates of Anti-VEGF, Corticosteroid Implants and Anti-Complement Injections: An IRIS®...

Area of Science:

• Ophthalmology
• Infectious Diseases
• Retinal Diseases

Background:

• Intravitreal injections are common treatments for various eye conditions.
• Endophthalmitis is a serious intraocular infection that can lead to vision loss.
• Understanding the incidence of endophthalmitis after different intravitreal agents is crucial for patient safety.

Purpose of the Study:

• To determine the incidence of endophthalmitis following intravitreal injections of various therapeutic agents.
• To compare the risk of endophthalmitis across different classes of intravitreal medications.

Main Methods:

• Retrospective cohort study utilizing the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight).
• Inclusion of adult and pediatric patients receiving intravitreal anti-VEGF agents, corticosteroid implants (fluocinolone acetonide, dexamethasone), avacincaptad pegol, or pegcetacoplan.
• Analysis of endophthalmitis cases diagnosed within 30 days post-injection from 2016 to 2024.

Main Results:

• The overall incidence of endophthalmitis was 3.5 per 10,000 cases.
• Higher rates were observed with corticosteroid implants (10-12 per 10,000) and pegcetacoplan (6.6 per 10,000) compared to anti-VEGF agents (3.3 per 10,000).
• Avacincaptad pegol showed an incidence of 4.9 per 10,000.

Conclusions:

• Intravitreal corticosteroid implants and anticomplement therapies are associated with a greater risk of endophthalmitis.
• Enhanced aseptic techniques may be necessary for injections involving larger gauge needles, immune modulation, or vial preparation.
• These findings inform clinical practice and highlight areas for improved safety protocols in ophthalmic procedures.