First Author: J.Lee UK
Co Author(s): B. Matthews
Back to previous
Intravitreal injections are the most commonly performed ophthalmological procedure and have become the standard of care for the treatment of a number of retinal conditions. The most serious and potentially devastating complication resulting from intravitreal injections is endophthalmitis. The purpose is to: 1) Determine and compare the rates of post-intravitreal injection endophthalmitis at Royal Bournemouth Hospital (RBH) over an eight-year period from 2008 to 2016. 2) Identify changes in practice and its effect on endophthalmitis rates.
Ophthalmology Department of The Royal Bournemouth Hospital, an acute district general hospital in England, UK.
The reported rates of post-injection endophthalmitis vary widely. Two meta-analyses have calculated the rate of endophthalmitis after anti-vascular endothelial growth factor (VEGF) injections to be 0.049% (52/105,536; McCannel 2011) and 0.056% (197/350,535; Fileta 2014). The total number of intravitreal injections performed was identified retrospectively from electronic records by the information department. The cases of post-intravitreal injection endophthalmitis were identified from the department’s written logbook record. The percentage rate was then calculated per year.
• The total number of intravitreal injections performed in RBH has increased year on year from 719 in 2008 to 4045 in 2016. This included both anti-vascular endothelial growth factor (VEGF) and steroid agents. • The post-intravitreal injection endophthalmitis rate ranges from a minimum of 0% in 2016 to a maximum of 0.15% in 2013. The mean annual rate over the eight-year period was 0.08%. • Endophthalmitis rates in %: 2008=0.14, 2009=0.09, 2010=0.12, 2011=0.06, 2012=0.05, 2013=0.15, 2014=0.03, 2015=0.06, 2016=0 • There were no cases of endophthalmitis following intravitreal dexamethasone injections. Key changes in practice at RBH: 2013: Introduction of the diabetic macular oedema (DMO) service following National Institute for Health and Care Excellence (NICE) approval of ranibizumab for treating DMO. 2014: Course of prophylactic chloramphenicol drops post-intravitreal injection stopped 2016: Introduction of nurse injectors
• Despite the rising number of intravitreal injections being performed each year, the rate of endophthalmitis is not increasing. • Royal Bournemouth Hospital has a mean annual post-intravitreal injection endophthalmitis rate of 0.08% from 2008 to 2016. • Changes in practice at RBH have not adversely affected the rates of endophthalmitis.