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, 2024. RESULTS: Endophthalmitis occurred following intravitreal injection in 3/29,802 (0.010%) eyes in 2021, 4/28,767 (0.014%) in 2022, 2/29,249 (0.004%) in 2023, and 1/27,549 (0.004%) in 2024. 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. 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 4-year time period was 0.0087% (10/115,367) and was similar to rates reported between 2005 and 2020 at the same institution (P = 0.48). 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 the current study, the incidence of endophthalmitis was similar to previously reported rates and did not differ between agents.