More Injections, Higher Risk? Unveiling the Endophthalmitis Trend

Intravitreal injections (IVIs) of anti-VEGF medications have revolutionized the treatment of various retinal diseases. While generally safe, a rare but serious complication is endophthalmitis, an inflammation of the eye’s interior. This recent study delves into the relationship between cumulative injection number and endophthalmitis risk, offering valuable insights for ophthalmologists managing patients on long-term IVI therapy.

Study Design and Findings:

  • Retrospective analysis: Researchers examined data from over 43,000 eyes receiving over 650,000 anti-VEGF injections (ranibizumab, aflibercept, and/or bevacizumab) at a single center.
  • Injection Quartiles: Eyes were divided into groups based on the number of injections received (quartiles).
  • Key Outcome: Endophthalmitis rates were analyzed per injection and per eye across different injection quartiles.


  • Overall Risk: The overall endophthalmitis risk was low, at 0.035% per injection (1 in 2857).
  • Cumulative Increase: With increasing injection numbers, the endophthalmitis risk per injection and per eye did increase.
  • Higher Early Risk: Interestingly, the risk increase was more pronounced during earlier injections (1-11), then slowed down as injections continued (67-126).

What it Means:

  • Awareness is Key: Recognizing that endophthalmitis risk, though low, increases with cumulative injections allows for informed discussions with patients regarding potential risks and benefits of continuing treatment.
  • Risk Stratification: The study suggests potentially higher risk during early injections, indicating the importance of strict sterile technique and vigilant patient monitoring during initial treatment phases.
  • Individualized Approach: As risk appears to plateau at higher injection numbers, a personalized approach considering underlying disease, response to treatment, and other individual factors remains crucial for managing long-term IVI therapy.

Remember: This research provides valuable insights, but further studies are needed to confirm these findings in diverse populations and treatment settings.


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