Post-intravitreal anti-VEGF endophthalmitis in the United Kingdom: incidence, features, risk factors, and outcomes

D.A. Lyall, A. Tey, B. Foot, S.T. Roxburgh, M. Virdi, Chris Robertson, C.J. MacEwen

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

To describe the incidence, features, management, and risk factors of post-intravitreal anti-VEGF endophthalmitis (PIAE) in patients undergoing treatment for exudative age-related macular degeneration in the United Kingdom.

Prospective observational case control study. Forty-seven cases of PIAE were identified through the British Ophthalmological Surveillance Unit from January 2009 to March 2010. Data collected at diagnosis and at 6 months follow-up included patient demographics, intravitreal injection details, pre- and post-injection management, visual acuity, clinical features and management of PIAE, causative organisms, and clinical outcomes. Details were compared with 200 control cases from 10 control centres to identify potential risk factors.

Estimated PIAE was 0.025%. Culture-positive PIAE incidence was 0.015%. Mean age of presentation was 78 years. Mean number of intravitreal injections before PIAE was 5. Mean days to presentation was 5 (range 1-39). Positive microbiology culture was found in 59.6%. The majority of causative organisms were Gram positive (92.8%). Significant risk factors were failure to administer topical antibiotics immediately after the injection (P=0.001), blepharitis (P=0.006), subconjunctival anaesthesia (P=0.021), patient squeezing during the injection (P=0.021), and failure to administer topical antibiotics before anti-VEGF injection (P=0.05).

The incidence of PIAE in the United Kingdom is comparable to other studies at a rate of 0.025%. The most common causative organisms were Gram positive. Measures to minimise the risk of PIAE include treatment of blepharitis before injection, avoidance of subconjunctival anaesthesia, topical antibiotic administration immediately after injection with consideration to administering topical antibiotics before injection.
LanguageEnglish
Pages1517-1526
Number of pages10
JournalEye
Volume26
Issue number12
Early online date12 Oct 2012
DOIs
Publication statusPublished - Dec 2012

Fingerprint

Endophthalmitis
Vascular Endothelial Growth Factor A
Incidence
Injections
Blepharitis
Anti-Bacterial Agents
Intravitreal Injections
Anesthesia
United Kingdom
Topical Administration
Macular Degeneration
Microbiology
Visual Acuity
Case-Control Studies
Demography

Keywords

  • post-intravitreal anti-VEGF endophthalmitis
  • exudative age-related macular degeneration
  • ophthalmological surveillance
  • risk factors

Cite this

Lyall, D.A. ; Tey, A. ; Foot, B. ; Roxburgh, S.T. ; Virdi, M. ; Robertson, Chris ; MacEwen, C.J. / Post-intravitreal anti-VEGF endophthalmitis in the United Kingdom : incidence, features, risk factors, and outcomes. In: Eye. 2012 ; Vol. 26, No. 12. pp. 1517-1526.
@article{46258ef3dc6746a2bdb6e817aa710693,
title = "Post-intravitreal anti-VEGF endophthalmitis in the United Kingdom: incidence, features, risk factors, and outcomes",
abstract = "To describe the incidence, features, management, and risk factors of post-intravitreal anti-VEGF endophthalmitis (PIAE) in patients undergoing treatment for exudative age-related macular degeneration in the United Kingdom.Prospective observational case control study. Forty-seven cases of PIAE were identified through the British Ophthalmological Surveillance Unit from January 2009 to March 2010. Data collected at diagnosis and at 6 months follow-up included patient demographics, intravitreal injection details, pre- and post-injection management, visual acuity, clinical features and management of PIAE, causative organisms, and clinical outcomes. Details were compared with 200 control cases from 10 control centres to identify potential risk factors.Estimated PIAE was 0.025{\%}. Culture-positive PIAE incidence was 0.015{\%}. Mean age of presentation was 78 years. Mean number of intravitreal injections before PIAE was 5. Mean days to presentation was 5 (range 1-39). Positive microbiology culture was found in 59.6{\%}. The majority of causative organisms were Gram positive (92.8{\%}). Significant risk factors were failure to administer topical antibiotics immediately after the injection (P=0.001), blepharitis (P=0.006), subconjunctival anaesthesia (P=0.021), patient squeezing during the injection (P=0.021), and failure to administer topical antibiotics before anti-VEGF injection (P=0.05).The incidence of PIAE in the United Kingdom is comparable to other studies at a rate of 0.025{\%}. The most common causative organisms were Gram positive. Measures to minimise the risk of PIAE include treatment of blepharitis before injection, avoidance of subconjunctival anaesthesia, topical antibiotic administration immediately after injection with consideration to administering topical antibiotics before injection.",
keywords = "post-intravitreal anti-VEGF endophthalmitis, exudative age-related macular degeneration, ophthalmological surveillance, risk factors",
author = "D.A. Lyall and A. Tey and B. Foot and S.T. Roxburgh and M. Virdi and Chris Robertson and C.J. MacEwen",
year = "2012",
month = "12",
doi = "10.1038/eye.2012.199",
language = "English",
volume = "26",
pages = "1517--1526",
journal = "Eye",
issn = "0950-222X",
number = "12",

}

Post-intravitreal anti-VEGF endophthalmitis in the United Kingdom : incidence, features, risk factors, and outcomes. / Lyall, D.A.; Tey, A.; Foot, B.; Roxburgh, S.T.; Virdi, M.; Robertson, Chris; MacEwen, C.J.

In: Eye, Vol. 26, No. 12, 12.2012, p. 1517-1526.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Post-intravitreal anti-VEGF endophthalmitis in the United Kingdom

T2 - Eye

AU - Lyall, D.A.

AU - Tey, A.

AU - Foot, B.

AU - Roxburgh, S.T.

AU - Virdi, M.

AU - Robertson, Chris

AU - MacEwen, C.J.

PY - 2012/12

Y1 - 2012/12

N2 - To describe the incidence, features, management, and risk factors of post-intravitreal anti-VEGF endophthalmitis (PIAE) in patients undergoing treatment for exudative age-related macular degeneration in the United Kingdom.Prospective observational case control study. Forty-seven cases of PIAE were identified through the British Ophthalmological Surveillance Unit from January 2009 to March 2010. Data collected at diagnosis and at 6 months follow-up included patient demographics, intravitreal injection details, pre- and post-injection management, visual acuity, clinical features and management of PIAE, causative organisms, and clinical outcomes. Details were compared with 200 control cases from 10 control centres to identify potential risk factors.Estimated PIAE was 0.025%. Culture-positive PIAE incidence was 0.015%. Mean age of presentation was 78 years. Mean number of intravitreal injections before PIAE was 5. Mean days to presentation was 5 (range 1-39). Positive microbiology culture was found in 59.6%. The majority of causative organisms were Gram positive (92.8%). Significant risk factors were failure to administer topical antibiotics immediately after the injection (P=0.001), blepharitis (P=0.006), subconjunctival anaesthesia (P=0.021), patient squeezing during the injection (P=0.021), and failure to administer topical antibiotics before anti-VEGF injection (P=0.05).The incidence of PIAE in the United Kingdom is comparable to other studies at a rate of 0.025%. The most common causative organisms were Gram positive. Measures to minimise the risk of PIAE include treatment of blepharitis before injection, avoidance of subconjunctival anaesthesia, topical antibiotic administration immediately after injection with consideration to administering topical antibiotics before injection.

AB - To describe the incidence, features, management, and risk factors of post-intravitreal anti-VEGF endophthalmitis (PIAE) in patients undergoing treatment for exudative age-related macular degeneration in the United Kingdom.Prospective observational case control study. Forty-seven cases of PIAE were identified through the British Ophthalmological Surveillance Unit from January 2009 to March 2010. Data collected at diagnosis and at 6 months follow-up included patient demographics, intravitreal injection details, pre- and post-injection management, visual acuity, clinical features and management of PIAE, causative organisms, and clinical outcomes. Details were compared with 200 control cases from 10 control centres to identify potential risk factors.Estimated PIAE was 0.025%. Culture-positive PIAE incidence was 0.015%. Mean age of presentation was 78 years. Mean number of intravitreal injections before PIAE was 5. Mean days to presentation was 5 (range 1-39). Positive microbiology culture was found in 59.6%. The majority of causative organisms were Gram positive (92.8%). Significant risk factors were failure to administer topical antibiotics immediately after the injection (P=0.001), blepharitis (P=0.006), subconjunctival anaesthesia (P=0.021), patient squeezing during the injection (P=0.021), and failure to administer topical antibiotics before anti-VEGF injection (P=0.05).The incidence of PIAE in the United Kingdom is comparable to other studies at a rate of 0.025%. The most common causative organisms were Gram positive. Measures to minimise the risk of PIAE include treatment of blepharitis before injection, avoidance of subconjunctival anaesthesia, topical antibiotic administration immediately after injection with consideration to administering topical antibiotics before injection.

KW - post-intravitreal anti-VEGF endophthalmitis

KW - exudative age-related macular degeneration

KW - ophthalmological surveillance

KW - risk factors

UR - http://www.scopus.com/inward/record.url?scp=84871051778&partnerID=8YFLogxK

U2 - 10.1038/eye.2012.199

DO - 10.1038/eye.2012.199

M3 - Article

VL - 26

SP - 1517

EP - 1526

JO - Eye

JF - Eye

SN - 0950-222X

IS - 12

ER -