Four-year review shows endophthalmitis remains a rare complication of intravitreal injections
Key Takeaways
- Endophthalmitis after intravitreal injection remained rare, with a cumulative incidence of 0.0087% across 115,367 injections from 2021 to 2024, consistent with previously reported rates at the same institution.
- No significant differences in endophthalmitis rates were found between anti-VEGF agents, despite changes in medication use over time, including increased faricimab and high-dose aflibercept use.
Endophthalmitis remains a rare complication of intravitreal injections despite shifts in anti-VEGF treatment patterns, according to a study.
Researchers conducted a retrospective case series of all patients who underwent intravitreal injection at the University of Miami’s Bascom Palmer Eye Institute from January 1, 2021, through December 31, 2024. Across 115,367 injections, 10 cases of endophthalmitis were identified, for a cumulative incidence of 0.0087%.
Annual rates were 0.010% in 2021, with 3 cases among 29,802 eyes; 0.014% in 2022, with 4 cases among 28,767 eyes; 0.004% in 2023, with 2 cases among 29,249 eyes; and 0.004% in 2024, with 1 case among 27,549 eyes.
During the study period, use of ranibizumab declined, while faricimab use increased. A slight rise in aflibercept use was also seen after approval of the 8 mg high-dose formulation in 2023. However, investigators found no significant differences in endophthalmitis rates between medications.
Among vitreous cultures, half were negative. Positive cultures included Streptococcus mitis/oralis, Staphylococcus aureus, Granulicatella adiacens, Staphylococcus epidermidis, and Abiotrophia defectiva, with each organism identified in one case.
After treatment, mean best-corrected visual acuity at last follow-up was 1.42 logMAR, equivalent to approximately 20/526, with outcomes ranging from 20/20 vision to no light perception.
Reference
Rohowetz LJ, Snow Z, Townsend JH, et al; or the Endophthalmitis Injection Study Group. Endophthalmitis associated with intravitreal injection: rates, culture results, and visual acuity outcomes. Retina. 2026;doi: 10.1097/IAE.0000000000004855. Epub ahead of print. PMID: 41989475.
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