Title

A 3-YEAR RETROSPECTIVE ANALYSIS OF ENDOPHTHALMITIS INCIDENCE IN THE INTRA-VITREOUS ANTIANGIOGENIC APPLICATION PROGRAM (PAAI) FOR THE TREATMENT OF AGE-RELATED MACULAR DEGENERATION EXUDATIVE FORM, DIABETIC MACULAR EDEMA AND RETINAL VEIN OCCLUSION

Introduction

Since the advent of molecular therapeutics targeting vascular endothelial growth factor (VEGF) in the 2000s, intravitreal injections (IVI) have become one of the most common ophthalmologic procedures and they are used as a mainstay of treatment for a variety of retinal pathologies(1). It is known that each injection of these agents carries an associated risk of endophthalmitis. Although the risk is low, endophthalmitis is a sight-threatening intraocular inflammation and, therefore, it remains one of the most feared complications(2). The main objective of this study is to determine, retrospectively, the incidence of endophthalmitis in the Intra-Vitreous Antiangiogenic Application Program (PAAI) at our institution.

Methods

This study included patients enrolled in PAAI at Cassiano Antonio Moraes University Hospital (HUCAM), located in Vitória - ES, Brazil. The Research Ethics Committee of HUCAM approved this study on April 26th, 2019 under registration number 01515718.7.0000.5071. HUCAM adopts a uniform protocol for IVI. All patients undergoing anti-VEGF IVI from January 2016 to December 2019 were identified and the incidence of endophthalmitis was established.

Results

A total of 7,275 anti-VEGF IVI were performed. Of the IVIs, bevacizumab was injected in 5,159 (70.91%) and ranibizumab in 2,116 (29.09%). From 2016 to 2019, 2 cases of endophthalmitis were reported, yielding an incidence rate of 0.027%. The incidence of endophthalmitis varied per year, with values fluctuating between 0 (2017 and 2019) and 0.07%(2018).

Discussion

This retrospective analysis of 7,275 IVIs of VEGF inhibitors performed in the sterile conditions in the operating room demonstrated a presumed endophthalmitis incidence of 0.027%. It was lower than incidences previously reported in the literature. The largest study to date evaluating endophthalmitis rates after anti-VEGF injection was the meta-analysis published by McCannel(3). Despite its limitations, this study appears to be one of the largest series to date in Brazil.

Keywords

Endophthalmitis; Intravitreal Injections; Bevacizumab; Ranibizumab.

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Area

CLINICAL CASE

Authors

Lívia Conci, Alexandre Pinheiro, Jéssica Frossard, Raquel Paiva, Fernanda Agostini, Kelcia Harchbart

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