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    Best practices for injection protocols

    Endophthalmitis after intravitreal injections: Can we do better?



    A year or so ago, my friend’s brother lost vision from choroidal neovascularization due to age-related macular degeneration (AMD). He received an intravitreal injection of an anti-vascular endothelial growth factor (VEGF) agent by a well-regarded retinal specialist in the Midwest. Within 48 hours, he had severe endophthalmitis and ultimately, lost all vision in the eye.

    Click here to read more from Dr. McDonnell

    I thought of my friend’s brother while reading an article recently on the topic of post-injection endophthalmitis in patients with age-related macular degeneration (AMD)—Yes, it is possible for refractive surgeons to read and even comprehend literature on retinal diseases, provided the authors avoid using big words. In the study, use of pre- and post-injection antibiotics was left to the discretion of the treating ophthalmologist, and the article concludes that the use or nonuse of antibiotics did not appear to influence the risk of infection.

    What caught my eye was the overall risk of infection and the authors’ take on that risk. Endophthalmitis developed after 11 of 18,509 injections (1 per 1,700; 0.06%) and in 11 of 1,185 patients (0.93%).

    “Wow!” I thought. “One percent of patients get endophthalmitis when treated with anti-VEGF therapy for AMD. That’s a big problem.”

    Depends on definition of ‘low’

    The paper offered a distinctly different interpretation, starting off the conclusions section with “Rates of endophthalmitis were low . . . .”

    Next: Driving down the rate

    Peter J. McDonnell, MD
    He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of ...

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