ENDOPHTHALMITIS ASSOCIATED WITH INTRAVITREAL INJECTION: Rates, Culture Results, and Visual Acuity Outcomes.

PURPOSE: To report the rates, culture results, and visual acuity outcomes of endophthalmitis after intravitreal injection.

METHODS

Retrospective, consecutive case series of all patients who underwent intravitreal injection at University of Miami-Bascom Palmer Eye Institute between January 1, 2021, and December 31, 2025.

RESULTS

Endophthalmitis occurred following intravitreal injection in 3/28,358 (0.011%) eyes in 2021, 3/24,918 (0.012%) in 2022, 3/24,840 (0.012%) in 2023, 1/28,831 (0.003%) in 2024, and 0/31,269 in 2025 (0%). The use of ranibizumab decreased with time in the current study while faricimab usage increased. There was a slight increase in aflibercept usage after the approval of high dose 8 mg aflibercept in 2023. Complement inhibitors pegcetacoplan and avacincaptad pegol, approved in 2023 for geographic atrophy, were administered in 1,894 and 423 eyes, respectively, in 2024, and 1,083 and 578 eyes, respectively, in 2025; no cases of endophthalmitis were associated with either agent. Vitreous cultures demonstrated growth of Streptococcus mitis/oralis in 1/10 (10%), Staphylococcus aureus in 1/10 (10%), Granulicatella adiacens in 1/10 (10%), Staphylococcus epidermis in 1/10 (10%), Abiotrophia defectiva in 1/10 (10%), and were negative in 5/10 (50%). The cumulative incidence of endophthalmitis over the 5-year time period was 0.0072% (10/138,216) and was similar to rates reported between 2005 and 2020 at the same institution (P = 0.18). There were no differences in the rates of endophthalmitis between various medications (P = 0.32). After treatment, mean best-corrected visual acuity at last follow-up examination was 1.42 logMAR (20/526; range: 20/20 to no light perception).

CONCLUSION

Endophthalmitis is a rare complication of intravitreal injection. In this study, the incidence of endophthalmitis was similar to previously reported rates and did not differ between agents.