Associate Professor I-Van Ho has spoken about the risk of endophthalmitis associated with intravitreal injection treatment (IVT) at a breakfast hosted by Novartis during the 2018 RANZCO Scientific Congress.
The number of people being treated with intravitreal injections has rapidly increased in recent years due to the rising number of people with retinal diseases.
Referring to a French study published in JAMA Ophthalmology,1 Assoc/Prof. Ho said the incidence of infectious and non-infectious endophthalmitis is low and the risk does not increase with successive injections. However, infection can occur and some patients can be extremely anxious about receiving injections because of this.
The French population based cohort study that Assoc/Prof. Ho referred to analysed 1,811,977 intravitreal injections of corticosteroids or anti-VEGF agents performed on 254,927 patients in France between 1 January 2012 and 31 December 2015. A total of 444 acute endophthalmitis cases were recorded. The study authors wrote that “although an association may not necessarily indicate a cause and effect, the risk for acute endophthalmitis after IVTs appeared to be higher for corticosteroids compared with anti-VEFG agents, while a lower risk of endophthalmitis appeared to be found with prefilled syringes of anti-VEGF medications”.1
Assoc/Prof. Ho said under-treatment of age related macular degeneration is the main driver for loss of vision, and the risk of infection should not deter ophthalmologists from administering treatment appropriate to their patients’ needs. Patients should be counselled about the low risk and cautioned to seek attention if they experience pain following an injection.
Novartis recently introduced a single dose solution for ranibizumab, which in line with study findings, is expected to further reduce the risk of infection associated with injection therapy.
- Florian Baudin, MD; Eric Benzenine, MSc; Anne-Sophie Mariet, MD; Alain M. Bron MD; Vincent Daien, MD, PhD; Jean Francois Korobelnik, MD, PhD; Catherine Quantin, MD, PhD; Catherine Creuzot-Garcher, MD, PhD. Association of acute endophthalmitis with intravitreal injections of corticosteroids or anti-vascular growth factor agents in a nationwide study in France. JAMA Ophthalmology. Doi:10.1001/jamaophthalmol.2018.3939. Published online September 13, 2018