Setting Does Not Impact Endophthalmitis Rates After Intravitreal Injection

Anti-VEGF treatments delivered in the office or in the operating room had equal rates of the complication, an analysis shows.

Researchers identified no differences in the rates of post-injection endophthalmitis in patients treated with intravitreal injections (IVI) of anti-vascular endothelial growth factor (VEGF) agents in an operating room (OR) compared with patients treated in offices, according to a meta-analysis published in JAMA Ophthalmology.

The investigators note that the office-based IVI is a more cost-effective and convenient approach for treatment, compared with OR-based treatment. However, the clinical outcomes seen in each setting had not previously been systematically evaluated, according to researchers. As such, investigators analyzed eligible studies reporting on patients who received IVIs with anti-VEGF drugs with a clearly stated injection setting of the office or OR. After reviewing 31 studies with a total of 1,275,815 injections, the comparative analysis found no difference between endophthalmitis rates after IVIs performed in the office or in the OR (P =.57). However, a higher rate of culture-positive endophthalmitis was found in the office setting (P =.006). The pooled rates of endophthalmitis following anti-VEGF IVIs were 0.03% (95% CI, 0.03-0.04) and 0.02% (95% CI, 0.01-0.04) in office and OR settings, respectively. The pooled rates of culture-positive endophthalmitis were 0.01% (95% CI, 0.01-0.02) and 0.01% (95% CI, 0-0.02). The pooled rates of other ocular and systemic adverse events were low.

Researchers conclude that the rate of clinically suspected or culture-positive endophthalmitis following anti-VEGF IVIs was low whether the procedure was performed in the office or the OR. However, the bacterial spectrum could differ between the 2 settings. Investigators could not determine if it is more appropriate to give treatment in the OR for safety reasons in low-income regions compared with higher-income regions of the world.

The study notes several limitations, including that endophthalmitis rates are especially low for the sample size. Also, most studies included in the review were retrospective case series. The significant heterogeneity of data from OR-based injections, and the fact that only 2 studies were directly comparative also limited the research.

“Using antisepsis from drug packaging and loading the syringes to the completion of IVIs in a well-controlled, clean environment may contribute to prophylaxis of postinjection endophthalmitis,” the researchers report.


Li T, Sun J, Min J, et al. Safety of receiving anti–vascular endothelial growth factor intravitreal injection in office-based vs operating room settings: a meta-analysis. JAMA Ophthalmol. Published online August 19, 2021. doi:10.1001/jamaophthalmol.2021.3096