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Endophthalmitis is more common after intravitreal injection of ranibizumab and aflibercept than bevacizumab

Session Details

Session Title: Quick Fire Free Paper 4

Session Date/Time: Sunday 14/09/2014 | 08:00-10:00

Paper Time: 08:10

Venue: Boulevard B

First Author: : C.Riemann USA

Co Author(s): :    M. Wilkes   R. Sisk   D. Miller   R. Foster   R. Hutchins   B. Genereux

Abstract Details

Purpose:

Concern has been raised in the scientific community and in the lay press regarding the safety of intravitreal injections of compounded medications. This led us to investigate endophthalmitis rates after injection of bevacizumab, ranibizumab, aflibercept, and triamcinolone at our institution.

Setting:

Retrospective analysis of the 12 year clinical experience of 6 Cincinnati Eye Institute surgeons working in 6 different officers in three different states.

Methods:

A retrospective analysis was performed on all patients who received intravitreal injections by six surgeons from January 2002 to July 2013 at the Cincinnati Eye Institute. All eyes in which a vitreous tap and inject was performed due to endophthalmitis concerns were counted as endophthalmitis suspects (ES). Patients in whom the vitreous tap was positive for bacterial growth were counted as culture positive endophthalmitis (CPE). Bevacizumab was supplied in preloaded syringes from a compounding pharmacy. Ranibizumab, aflibercept, and triamcinolone were supplied in vials and manually drawn up into syringes immediately prior to injection.

Results:

71,988 injections were performed: 49,756 bevacizumab, 11,480 ranibizumab, 7,774 triamcinolone, 2,590 aflibercept, and 388 pegaptanib. 55 eyes were classified as ES (1/1309 or 0.08%) and 15 of these were CPE (1/4799 or 0.02%). Of the 55 eyes with ES, 14 occurred after bevacizumab (1/3554 or 0.03%), 13 after ranibizumab (1/833 or 0.11%), 25 (1/311 or 0.32%) after triamcinolone, and 3 after aflibercept (1/833 or 0.12%). Of the 15 eyes with CPE, 5 occurred after bevacizumab (1/9951 or 0.01%), 7 after ranibizumab (1/1640 or 0.06%), and 3 (1/2551 or 0.04%) after triamcinolone.

Conclusions:

At the Cincinnati Eye Institute, intravitreal injection of bevacizumab has a much lower rate of endophthalmitis than intravitreal injection of any other drug. We suggest that the highly publicized risks of infectious endophthalmitis after injection of compounded medications be rationally compared to the real and possibly greater endophthalmitis risk associated with injection of drugs supplied in vials whether compounded or not. Furthermore, our data suggests that drugs prepared for injection under sterile conditions such as a compounding pharmacy or sterile manufacturing facility are associated with a markedly lower rate of infection than those drawn up for injection in the clinic.

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