First Author: H.Kolli UK
Co Author(s): S. Elsherbiny
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Intravitreal injections have been used in the management of several conditions in the last decade. However there has been a dramatic increase in the number of injections being performed annually, especially anti vascular endothelial growth factor (anti-VEGF) and the risk of endophthalmitis is a potential concern. Although there are several guidelines for intravitreal injection procedures, there are no specific guidelines regarding performing the injections in immunocompromised patients. Immunocompromised patients potentially have a greater risk of developing endophthalmitis. The aim of our study is to review immunocompromised patients receiving the injections.
Tertiary referral centre
4 patients were included in the study who received intravitreal injections for wet macular degeneration. M: F, 3:1, Age 66-88, mean 75.7 years. All had intravitreal ranibizumab with 2 patients being switched to Aflibercept injections .1 Patient had severe neutropenia of unknown aetiology, 1 patient had a malignant brain tumour with metastasis, 1 patient had bowel cancer and another was diagnosed with breast cancer. Each of these patients attended our outpatient injection clinic. On each visit they were secluded from the main waiting area, injected first on the list and discharged immediately. All injections were timed to coincide at the midpoint of their chemotherapy free period. All patients received 5 days post injection topical antibiotics as per departmental protocol prevalent at that time
All patients had undergone uneventful intravitreal injections despite their immunocompromised status. None had any complications
There is a potential additional risk of infection post intravitreal injections in immune compromised patients. To minimize the risk of infection post-injection, timing their injections at the midpoint of their chemotherapy free periods and decreasing their time spent in the department are options to be considered while listing these patients for injections. Immunocompromised patients are likely to benefit form a short course of topical antibiotics to reduce the risk of infection. With the increased prevalence of cancer, the increased survival rates and increased indications for intravitreal injections, this is a cohort that may be expected to increase with time. However a larger prospective study is required to address their specific propensity to complications