Visual Outcomes Following Infectious Endophthalmitis from Intravitreal Injections of Biologic Drugs: An Intelligent Research in Sight Registry Retrospective Analysis

INTRODUCTION: Intravitreal (IVT) injections are now among the most frequently performed intraocular procedures globally. Evidence regarding post-IVT-injection infectious endophthalmitis is primarily derived from a limited number of randomized controlled trials and retrospective case series. This study assesses visual acuity outcomes after IVT biologic therapy utilizing data from a large-scale ophthalmic registry, with the objective of elucidating the real-world effects of post-IVT-injection infectious endophthalmitis on patient visual function. METHODS: ) Registry, focusing on subjects who received commercially available IVT anti-VEGF and anti-complement biologic drugs. RESULTS: As of 31 December 2024, 1,998,399 individuals received at least one IVT injection in one or both eyes, and 13,074 subjects (affecting 13,317 eyes) were diagnosed with infectious endophthalmitis. Incidence of infectious endophthalmitis per IVT injection was 0.052%. The cumulative rate of infectious endophthalmitis per subject rose from 0.31% after 10 IVT injections to 0.58% after 60 injections. The proportion of subjects who were legally blind (defined as ≤ 35 letters or ≤ 20/200) increased from 19.4% before the infectious endophthalmitis event to 46.1% afterward. In total, 94 eyes affected by infectious endophthalmitis underwent evisceration or enucleation. Subjects with retinal vein occlusion and myopic choroidal neovascularization had the highest incidence rates of infectious endophthalmitis compared with those with neovascular (wet) age-related macular degeneration and diabetic macular edema/diabetic retinopathy. CONCLUSIONS: In the real world, the cumulative incidence of infectious endophthalmitis per subject is positively correlated with the total number of IVT injections administered. While the incidence of post-IVT-injection infectious endophthalmitis was comparable to literature values reported after cataract surgery, visual acuity outcomes were worse in the post-IVT injection group. Implementing strategies aimed at reducing IVT injection frequency may have the potential to lower the incidence of infectious endophthalmitis and the consequent risk of significant vision loss.