Comparative Endophthalmitis Rates of Anti-VEGF, Corticosteroid Implants and Anti-Complement Injections: An IRIS Registry Analysis.

PURPOSE: To evaluate the incidence of endophthalmitis after intravitreal injections using a large, national ophthalmic registry.

DESIGN: Retrospective clinical cohort study.

METHODS: Patients in the American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight) who received intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents, fluocinolone acetonide (Iluvien, Yutiq), avacincaptad pegol (Izervay), pegcetacoplan (Syfovre), or dexamethasone (Ozurdex) were included in this analysis. Data from pediatric and adult patients in the IRIS Registry who were diagnosed with acute endophthalmitis within 30 days after intravitreal injections from 2016 to 2024 were collected.

RESULTS: The overall incidence of endophthalmitis in adults was 3.5 per 10,000 cases with rates of 3.3 per 10,000 after anti-VEGF, 4.9 per 10,000 after avacincaptad pegol, 6.6 per 10,000 after pegcetacoplan, 10 per 10,000 and 8 per 10,000 after fluocinolone acetonide (Iluvien and Yutiq, respectively), and 12 per 10,000 after dexamethasone implant. The rate of endophthalmitis was significantly higher for corticosteroid implants and pegcetacoplan compared to anti-VEGF injections. Over the past years, there were statistically significant yet small fluctuations in endophthalmitis incidence for anti-VEGF injections ranging from 2.4 per 10,000 in 2021 to 4 per 10,000 in 2020.

CONCLUSIONS AND RELEVANCE: The incidence of post-injection endophthalmitis is greater with corticosteroid implants and anticomplement therapies. Heightened aseptic vigilance may be warranted with injections that necessitate larger gauge needles, modulate the immune response and/or are prepared from a vial.