Office safer than the operating theatre for intravitreal injections

The incidence of endophthalmitis following injections of anti-VEGF drugs is lower when the injections are given in an office setting than the rates reported from clinical trials, which require a more extensive pre-injection regimen, according to the results of a study published online ahead of print by the American Journal of Ophthalmology.

Suman Pilli from the Vitreous Retina Macula Consultants of New York and colleagues from centres across the US and UK, carried out a retrospective interventional case series to determine the incidence of endophthalmitis following intravitreal injections of anti-VEGF agents. A total of 10,254 intravitreal injections were performed between 5th January 2005 and 18th October 2007 (406 pegaptanib, 3,501 bevacizumab and 6,347 ranibizumab). The injections were performed as an office-based procedure, using povidone-iodine as part of the pre-injection preparation. Pre-injection antibiotics, eye drape or surgical attire were not used.

Overall, there were just three cases of suspected endophthalmitis, one case following bevacizumab injection and two cases following ranibizumab injection. There were no cases of culture-proven endophthalmitis and all three patients regained their pre-injection visual acuity.

Compared to the stricter procedures used in clinical trials, office-based injection procedures actually result in fewer cases of endophthalmitis, conclude the authors of this study.