Advertisement

Endophthalmitis after intravitreal injections versus cataract surgery: a 15-year cohort

  • Nimrod DarEmail author
  • Shani Pillar
  • Asaf Friehmann
  • Avner Belkin
  • Shay Ofir
Original Paper
  • 11 Downloads

Abstract

Purpose

To compare the clinical features, visual outcomes and causative organisms between endophthalmitis secondary to cataract surgery or to intravitreal injections (IVI).

Setting

Meir Medical Center, Kfar Saba, Israel.

Design

Retrospective, non-randomized comparative chart review.

Methods

Medical records of patients with proven or suspected endophthalmitis admitted to the Ophthalmology Department at Meir Medical Center 2/2002–2/2017 were reviewed. Clinical characteristics including presenting and final visual acuity (VA) outcomes, causative organisms and time to admission were assessed.

Results

Among 84 patients in our study, 35 had preceding cataract surgery and 12 had preceding IVI. The post-cataract group showed a significant improvement in VA following treatment with a presenting and final VA (logMar ± SD) of (1.80 ± 0.54 and 1.39 ± 0.65, P < 0.01) as opposed to the post-IVI group (1.72 ± 0.26 and 1.81 ± 0.32, P = 0.692), while most patients in the cataract group exhibited some degree of VA recovery (70.96%). Patients undergoing cataract surgery were divided into two separate groups; those who underwent cataract surgery in a private center and those operated at a public center. Patients undergoing surgery at a private medical center showed improvement in VA outcomes following treatment (1.80 ± 0.57 and 1.13 ± 0.66, P < 0.01) as opposed to those operated on at our public medical center.

Conclusions

Overall, patients with endophthalmitis following cataract surgery had better visual outcomes and were more likely to show a VA improvement following treatment when compared with endophthalmitis following IVI. Final VA outcomes of patients with endophthalmitis after cataract surgery performed in a private center were better than those operated on and treated in a public medical center.

Keywords

Endophthalmitis Intravitreal injections Cataract surgery 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

No conflicting relationship exists for any author.

References

  1. 1.
    Jabbarvand M, Hashemian H, Khodaparast M, Jouhari M, Tabatabaei A, Rezaei S (2016) Endophthalmitis occurring after cataract surgery: outcomes of more than 480 000 cataract surgeries, epidemiologic features, and risk factors. Ophthalmology 123:295–301CrossRefGoogle Scholar
  2. 2.
    Miller JJ, Scott IU, Flynn HW Jr et al (2005) Acute-onset endophthalmitis after cataract surgery (2000–2004): incidence, clinical settings, and visual acuity outcomes after treatment. Am J Ophthalmol 139:983–987CrossRefGoogle Scholar
  3. 3.
    Prashant G, Aravind R, Savitri S (2017) Endophthalmitis after cataract surgery: epidemiology, risk factors, and evidence on protection. Curr Opin Ophthalmol 28:67–72CrossRefGoogle Scholar
  4. 4.
    Reibaldi M (2018) Pooled estimates of incidence of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents with and without topical antibiotic prophylaxis. Retina 38:1–11CrossRefGoogle Scholar
  5. 5.
    Sigford DK, Reddy S, Mollineaux C, Schaal S (2015) Global reported endophthalmitis risk following intravitreal injections of anti-VEGF: a literature review and analysis. Clin Ophthalmol 9:773–781Google Scholar
  6. 6.
    Fileta JB, Scott IU, Flynn HW (2014) Meta-analysis of infectious endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents. Ophthalmic Surg Lasers Imaging Retina 45:143–149CrossRefGoogle Scholar
  7. 7.
    Yannuzzi NA, Si N, Relhan N, Kuriyan AE, Albini TA, Berrocal AM, Davis JL, Smiddy WE, Townsend J, Miller D et al (2017) Endophthalmitis after clear corneal cataract surgery: outcomes over two decades. Am J Ophthalmol 174:155–159CrossRefGoogle Scholar
  8. 8.
    Peyman GA, Lad EM, Moshfegh DM (2009) Intravitreal injection of therapeutic agents. Retina 29:875–912CrossRefGoogle Scholar
  9. 9.
    Lalwani GA, Flynn HW Jr, Scott IU, Quinn CM, Berrocal AM, Davis JL, Murray TG, Smiddy WE, Miller D (2008) Acute-onset endophthalmitis after clear corneal cataract surgery (1996–2005). Clinical features, causative organisms, and visual acuity outcomes. Ophthalmology 115:473–476CrossRefGoogle Scholar
  10. 10.
    Falavarjani KG, Nguyen QD (2013) Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature. Eye 27:787–794CrossRefGoogle Scholar
  11. 11.
    McCannel CA (2011) Meta-analysis of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents: causative organisms and possible prevention strategies. Retina 31:654–661CrossRefGoogle Scholar
  12. 12.
    Schulze-Bonsel K, Feltgen N, Burau H et al (2006) Visual acuities ‘‘hand motion’’ and ‘‘counting fingers’’ can be quantified with the Freiburg visual acuity test. Investig Ophthalmol Vis Sci 47:1236–1240CrossRefGoogle Scholar
  13. 13.
    Scott IU, Flynn HW Jr, Acar N et al (2011) Incidence of endophthalmitis after 20-gauge vs 23-gauge vs 25-gauge pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol 249:377–380CrossRefGoogle Scholar
  14. 14.
    Taban M, Behrens A, Newcomb RL, Nobe MY, McDonnell PJ (2005) Incidence of acute endophthalmitis following penetrating keratoplasty: a systematic review. Arch Ophthalmol 123(5):605–609CrossRefGoogle Scholar
  15. 15.
    Al-Torbak AA, Al-Shahwan S, Al-Jadaan I et al (2005) Endophthalmitis associated with the Ahmed glaucoma valve implant. Br J Ophthalmol 89:454–458CrossRefGoogle Scholar
  16. 16.
    Mino de Kaspar H, Shriver EM, Nguyen EV et al (2003) Risk factors for antibiotic-resistant conjunctival bacterial flora in patients undergoing intraocular surgery. Graefes Arch Clin Exp Ophthalmol 241:730–733CrossRefGoogle Scholar
  17. 17.
    Kernt M, Kampik A (2010) Endophthalmitis: pathogenesis, clinical presentation, management, and perspectives. Clin Ophthalmol 4:121–135CrossRefGoogle Scholar
  18. 18.
    Gower EW, Keay LJ, Stare DE, Arora P, Cassard SD, Behrens A, Tielsch JM, Schein OD (2015) Characteristics of endophthalmitis after cataract surgery in the United States medicare population. Ophthalmology 122:1625–1632CrossRefGoogle Scholar
  19. 19.
    Morlet N, Li J, Semmens J, Ng J (2003) The endophthalmitis population study of Western Australia (EPSWA). Br J Ophthalmol 87:574–576CrossRefGoogle Scholar
  20. 20.
    Barry P, Seal DV, Gettinby G et al (2006) ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: preliminary report of principal results from a European multicenter study. J Cataract Refract Surg 32:407–410CrossRefGoogle Scholar
  21. 21.
    Shah CP, Garg SJ, Vander JF et al (2011) Outcomes and risk factors associated with endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents. Ophthalmology 118:2028–2034CrossRefGoogle Scholar
  22. 22.
    Lemley CA, Han DP (2007) Endophthalmitis: a review of current evaluation and management. Retina 27:662–680CrossRefGoogle Scholar
  23. 23.
    Pathengay A, Moreker MR, Puthussery R et al (2011) Clinical and microbiologic review of culture-proven endophthalmitis caused by multidrug-resistant bacteria in patients seen at a tertiary eye care center in southern India. Retina 31:1806–1811CrossRefGoogle Scholar
  24. 24.
    Simunovic MP, Rush RB, Hunyor AP, Chang AA (2012) Endophthalmitis following intravitreal injection versus endophthalmitis following cataract surgery: clinical features, causative organisms and post-treatment outcomes. Br J Ophthalmol 96:862–866CrossRefGoogle Scholar
  25. 25.
    Endophthalmitis Vitrectomy Study Group (1995) A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol 113:1479–1496CrossRefGoogle Scholar
  26. 26.
    Storey P, Dollin M, Pitcher J et al (2014) The role of topical antibiotic prophylaxis to prevent endophthalmitis after intravitreal injection. Ophthalmology 121:283–289CrossRefGoogle Scholar
  27. 27.
    Rizzo JL, Chin EK, Rashid S, Park SS (2012) Exogenous endophthalmitis: post-operative versus post-intravitreal injection. Vis Pan Am 11:38–43Google Scholar
  28. 28.
    Sommer A, Belkin A, Ofir S, Assia E (2017) Profile of patients presenting for cataract surgery in a public hospital: a 15 year perspective. Isr Med Assoc J 19:109–113Google Scholar
  29. 29.
    Antcliff RJ, Spalton DJ, Stanford MR et al (2001) Intravitreal triamcinolone for uveitic cystoid macular edema: an optical coherence tomography study. Ophthalmology 108:765–772CrossRefGoogle Scholar
  30. 30.
    Greenberg PB, Martidis A, Rogers AH et al (2002) Intravitreal triamcinolone acetonide for macular oedema due to central retinal vein occlusion. Br J Ophthalmol 86:247–248CrossRefGoogle Scholar
  31. 31.
    Jonas JB, Sofker A (2001) Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular edema. Am J Ophthalmol 132:425–427CrossRefGoogle Scholar
  32. 32.
    Sutter FKP, Gillies MC (2003) Pseudo-endophthalmitis after intravitreal injection of triamcinolone. Br J Ophthalmol 87:972–974CrossRefGoogle Scholar
  33. 33.
    Nelson ML, Tennant MTS, Sivalingam A, Regillo CD, Belmont JB, Martidis A (2003) Infectious and presumed noninfectious endophthalmitis after intravitreal triamcinolone acetonide injection. Retina 23:686–691CrossRefGoogle Scholar
  34. 34.
    Taban M, Singh RP, Chung J, Lowder CY, Perez VL, Kaiser PK (2007) Sterile endophthalmitis after intravitreal triamcinolone: a possible association with uveitis. Am J Ophthalmol 144:50–54CrossRefGoogle Scholar
  35. 35.
    Sakamoto T, Enaida H, Kubota T, Nakahara M, Yamakiri K, Yamashita T, Yokoyama M, Hata Y, Murata T, Miyata K et al (2004) Incidence of acute endophthalmitis after triamcinolone-assisted pars plana vitrectomy. Am J Ophthalmol 138:137–138CrossRefGoogle Scholar
  36. 36.
    Fong A, Chan C (2017) Presumed sterile endophthalmitis after intravitreal triamcinolone (Kenalog)-more common and less benign than we thought? Asia Pac J Ophthalmol 6:45–49CrossRefGoogle Scholar
  37. 37.
    Marticorena J, Romano V, Gómez-Ulla F (2012) Sterile endophthalmitis after intravitreal injections. Mediat Inflamm 2012:92812CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
  2. 2.Department of OphthalmologyMeir Medical CenterKfar SabaIsrael

Personalised recommendations