Endophthalmitis rates following intravitreal injection of aflibercept using a prefilled syringe – a multicenter study

PURPOSE: To evaluate endophthalmitis rates following intravitreal injection of aflibercept, comparing between vial preparation and prefilled syringe use. METHODS: We retrospectively collected data from ten ophthalmology departments in Israel. The number of intravitreal anti-VEGF injections administered in years 2022 and 2023 was recorded. Endophthalmitis rates in 2022 (vial use) and in 2023 (prefilled syringe use) were compared. Clinical details of endophthalmitis cases were reviewed. RESULTS: In 2022, out of 119,904 intravitreal injections, 31,991 (27%) were aflibercept injections prepared from vials. In 2023, out of 128,306 intravitreal injections, 35,589 (28%) were aflibercept injections from prefilled syringes. Endophthalmitis rates were similar between vial preparation (1:1991) and prefilled syringe (1:2372) (p = 0.63). Notably, aflibercept injections exhibited significantly higher endophthalmitis rates compared to bevacizumab and ranibizumab combined, in both years (1:1999 vs. 1:5494 in 2022, and 1:2373 vs. 1:7132 in 2023, respectively; p < 0.01 for both). CONCLUSION: Despite the transit to prefilled aflibercept syringes, endophthalmitis rates following aflibercept injection did not decrease. Post-injection endophthalmitis rates were significantly higher with aflibercept compared to bevacizumab and ranibizumab, with both vial and prefilled syringe.