Comparison of Endophthalmitis Rates Between Prefilled Syringes and Standard Vials in Aflibercept Intravitreal Injections: A Retrospective Study in Japan
<b>Background:</b> Bacterial endophthalmitis is a rare but serious complication of intravitreal injections (IVIs). Prefilled syringes have been introduced to reduce contamination risk during drug preparation. However, whether they lower the incidence of bacterial endophthalmitis compared to vials remains unclear. <b>Methods:</b> This retrospective cohort study analyzed aflibercept IVIs performed at 17 clinical centers in Japan between 2015 and 2022. Patients aged ≥20 years who received aflibercept IVIs (vial or prefilled syringe) for age-related macular degeneration, diabetic macular edema, retinal vein occlusion, or myopic choroidal neovascularization were included. Bacterial endophthalmitis was diagnosed based on clinical signs (e.g., rapid vision loss, pain, hypopyon, vitreous opacity). Incidence rates were compared using Fisher's exact test. <b>Results:</b> Among 152,039 injections (43,684 prefilled syringes; 108,355 vials), 12 cases of bacterial endophthalmitis were identified (0.0046% vs. 0.0092%, <i>p</i> = 0.53). Poor visual outcomes were associated with <i>Enterococcus faecalis</i>, <i>Streptococcus</i> spp., and diabetes. <b>Conclusions:</b> Although incidence was lower in the prefilled syringe group, the difference was not statistically significant. Detecting a significant difference requires a larger sample. Further studies are needed to confirm the potential benefits of prefilled syringes in reducing endophthalmitis risk.
Authors
- Masahiko Shimura (ORCID: https://orcid.org/0000-0001-5456-6374)
- Aki Kato (ORCID: https://orcid.org/0000-0001-9350-6809)
- Hitoshi Tabuchi (ORCID: https://orcid.org/0000-0002-9098-0430)
- Kozo Harimoto
- Tatsuya Jujo (ORCID: https://orcid.org/0000-0001-6119-3377)
- Yoshihiro Takamura (ORCID: https://orcid.org/0000-0003-0418-6829)
- Sentaro Kusuhara (ORCID: https://orcid.org/0000-0002-6458-539X)
- Masakazu Morioka (ORCID: https://orcid.org/0000-0002-8963-8064)
- Tomoya Murakami (ORCID: https://orcid.org/0000-0001-5421-8580)
- Hisashi Matsubara (ORCID: https://orcid.org/0000-0003-1890-5417)
- Takao Hirano (ORCID: https://orcid.org/0000-0003-3601-8053)
- Masashi Nishigaki
- Mariko Sasaki (ORCID: https://orcid.org/0000-0001-5608-0546)
- Yoshinori Mitamura (ORCID: https://orcid.org/0000-0002-4813-672X)
- Tomoko Sawada (ORCID: https://orcid.org/0000-0002-9828-4288)
- Shigeo Yoshida (ORCID: https://orcid.org/0000-0003-1049-8909)
- Daisuke Nagasato (ORCID: https://orcid.org/0000-0003-3956-9352)
- Masaru Inatani (ORCID: https://orcid.org/0000-0003-0896-996X)
- Tetsuo Ueda
- Junya Mori
Institutions
- Kurume University (JP)
- University of Fukui (JP)
- Shinshu University (JP)
- University of Tsukuba (JP)
- Shiga University of Medical Science (JP)
- St. Marianna University School of Medicine (JP)
- Aichi Medical University (JP)
- Mie University (JP)
- Keio University (JP)
- Nagoya City University (JP)
- Tokyo Medical University Hachioji Medical Center (JP)
- Tachikawa Hospital (JP)
- Sapporo City General Hospital (JP)
- National Defense Medical College (JP)
- Nara Medical University (JP)
- Kobe University (JP)
- Tokushima University (JP)
Publication Details
- Journal
- Journal of Clinical Medicine
- Published
- 2025-04-06
- DOI
- https://doi.org/10.3390/jcm14072491
- Primary Topic
- Ocular Infections and Treatments
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Kagoshima University