Endophthalmitis — a rare but dangerous complication of intravitreal anti-VEGF injections

Agents blocking vascular endothelial growth factor (anti-VEGF) — aflibercept, bevacizumab, and ranibizumab are commonly used drugs in the treatment of retinal vascular diseases, including age-related macular degeneration, diabetic retinopathy, retinal vascular occlusions and retinopathy of prematurity. To date, intravitreal injection is the only successful administration method of anti-VEGF agents. Each administration can potentially lead to rhegmatogenous retinal detachment, intraocular pressure elevation, ocular hemorrhage, and endophthalmitis. Endophthalmitis is a rare complication, occurring in 0.012–0.1% of cases of anti-VEGF injections. The most frequent isolated pathogens are Staphylococcus spp. And Streptococcus viridans — commensals of the human upper respiratory and oral flora. The main symptoms of endophthalmitis are pain and decreased visual acuity. Patients become symptomatic on average three days after the injection. Prevention of endophthalmitis includes sterilization of ocular surface with povidone-iodine, use of sterile gloves, use of eye speculum, and „no-talking” policy. Topical antibiotics are not routinely used as they can even increase the risk of post-injection endophthalmitis. It is essential to estimate the risk factors and prevention methods to reduce post-injection endophthalmitis rates in the future.