Endophthalmitis rates among patients receiving intravitreal anti-VEGF injections: a USA claims analysis

Szilárd Kiss; Pravin U Dugel; Arshad M Khanani; Michael S Broder; Eunice Chang; Gordon H Sun; Adam Turpcu

doi:10.2147/OPTH.S169143

Endophthalmitis rates among patients receiving intravitreal anti-VEGF injections: a USA claims analysis

Clin Ophthalmol. 2018 Aug 30:12:1625-1635. doi: 10.2147/OPTH.S169143. eCollection 2018.

Authors

Szilárd Kiss¹, Pravin U Dugel^{2

3}, Arshad M Khanani⁴, Michael S Broder⁵, Eunice Chang⁵, Gordon H Sun⁵, Adam Turpcu⁶

Affiliations

¹ Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA, szk7001@med.cornell.edu.
² Retinal Consultants of Arizona, Phoenix, AZ, USA.
³ USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁴ Sierra Eye Associates, Reno, NV, USA.
⁵ Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA.
⁶ Genentech, Inc., South San Francisco, CA, USA.

Abstract

Purpose: Intravitreal (IVT) injections of the anti-vascular endothelial growth factor (VEGF) agents aflibercept, bevacizumab, and ranibizumab are commonly prescribed to treat neovascular age-related macular degeneration (nAMD). Studies comparing inflammation rates in large populations of patients receiving these agents and the treatment of ocular inflammation post-IVT anti-VEGF injections are scarce. In this study, we compared rates of endophthalmitis claims (sterile and infectious) following IVT anti-VEGF injections to determine the risk factors associated with developing endophthalmitis, and examined the claims for subsequent treatment.

Patients and methods: This retrospective cohort study of USA claims data examined the risk of developing endophthalmitis following IVT injection of aflibercept, bevacizumab, or ranibizumab in patients with nAMD between 11/18/2011 and 5/31/2013. The primary study outcome was occurrence of endophthalmitis within 30 days of a claim for an IVT anti-VEGF injection. Endophthalmitis rates were calculated separately for aflibercept, bevacizumab, and ranibizumab, followed by pairwise comparisons of endophthalmitis frequencies among the 3 treatments.

Results: This analysis included 818,558 injections from 156,594 patients with nAMD. The rates (% [n/N]) of endophthalmitis following aflibercept, bevacizumab, and ranibizumab IVT injections were 0.100% (136/135,973), 0.056% (268/481,572), and 0.047% (94/201,013), respectively. In a multivariate analysis, aflibercept was associated with a significantly higher risk of endophthalmitis vs ranibizumab (adjusted odds ratio, 2.19; 95% CI: 1.68-2.85; P<0.0001). The risk of endophthalmitis was similar for bevacizumab and ranibizumab. Within 14 days after endophthalmitis, 38.6% of cases received injectable antibiotics, 15.3% received injectable steroids, and 30.3% underwent vitrectomy.

Conclusion: The rate of endophthalmitis was very low, but higher following IVT injection with aflibercept compared with both bevacizumab and ranibizumab in patients with nAMD.

Keywords: aflibercept; bevacizumab; ranibizumab; regression analysis.