Intravitreal Injection Guidelines

With an increase in the number of intravitreal injections especially intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents the risk for endophthalmitis is a potential concern. A meta-analysis by Jager et al. shows that the prevalence of endophthalmitis following intravitreal injections is low. They evaluated the incidence of endophthalmitis into infectious and non-infectious categories and found that the endophthalmitis rate was 0.9% (38/4382) per eye and 0.3% (38/14 866) per injection, when looking at both infectious and non-infectious cases. They also found endophthalmitis rate of 1.4% per injection for intravitreal triamcinolone acetonide and 0.2% per injection for intravitreal ranibizumab. The risk of endophthalmitis after intravitreal injection may vary with various drugs. The reported incidence of endophthalmitis per patient in multicenter clinical trials with anti-vascular endothelial growth factor (VEGF) therapy ranged from 0.019 to 1.6%. Although cases of acute endophthalmitis following intravitreal bevacizumab (IVB) have occurred, the exact incidence rate remains unknown. The injection technique and compounding issues of bevacizumab remains the major areas of concern. Ranibizumab comes as a single use vial so the concerns are limited to injection techniques. These guidelines are framed to reduce the risk of endophthalmitis by streamlining the compounding and injection techniques with special reference to bevacizumab. The risk for endophthalmitis following Intravitreal Injections could be: