The Impact of Prefilled Syringes on Endophthalmitis Following Intravitreal Injection of Ranibizumab.

Autor: Storey PP; Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Tauqeer Z; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA., Yonekawa Y; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA., Todorich B; Pennsylvania Retina Specialists, PC, Camp Hill, Pennsylvania, USA., Wolfe JD; Associated Retina Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA., Shah SP; Rutgers Robert Wood Johnson Medical School, NJ Retina, New Brunswick, New Jersey, USA., Shah AR; Retina Consultants of Houston, Blanton Eye Institute, Houston, Texas, USA., Koto T; Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan., Abbey AM; Texas Retina Associates, Dallas, Texas, USA., Morizane Y; Department of Ophthalmology, Okayama University Medical School, Okayama, Japan., Sharma P; Ophthalmic Consultants of Boston, Tufts University School of Medicine, Boston, Massachusetts, USA., Wood EH; Associated Retina Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA., Morizane-Hosokawa M; Department of Ophthalmology, Okayama University Medical School, Okayama, Japan., Pendri P; Rutgers Robert Wood Johnson Medical School, NJ Retina, New Brunswick, New Jersey, USA., Pancholy M; Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Harkey S; Retina Consultants of Houston, Blanton Eye Institute, Houston, Texas, USA., Jeng-Miller KW; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA., Obeid A; Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Borkar DS; Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Chen E; Retina Consultants of Houston, Blanton Eye Institute, Houston, Texas, USA., Williams P; Texas Retina Associates, Dallas, Texas, USA., Okada AA; Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan., Inoue M; Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan., Shiraga F; Department of Ophthalmology, Okayama University Medical School, Okayama, Japan., Hirakata A; Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan., Shah CP; Ophthalmic Consultants of Boston, Tufts University School of Medicine, Boston, Massachusetts, USA., Prenner J; Rutgers Robert Wood Johnson Medical School, NJ Retina, New Brunswick, New Jersey, USA., Garg S; Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. Electronic address: sgarg@midatlanticretina.com.
Jazyk: angličtina
Zdroj: American journal of ophthalmology [Am J Ophthalmol] 2019 Mar; Vol. 199, pp. 200-208. Date of Electronic Publication: 2018 Dec 13.
DOI: 10.1016/j.ajo.2018.11.023
Abstrakt: Purpose: To compare the rates of infectious endophthalmitis following intravitreal injection of ranibizumab using prefilled syringes vs conventional preparation.
Design: Multicenter retrospective cohort study.
Methods: All eyes receiving intravitreal injection of 0.5 mg ranibizumab for retinal vascular diseases at 10 retina practices across the United States (2016 to 2017) and Japan (2009 to 2017) were included. The total numbers of eyes and injections were determined from billing codes. Endophthalmitis cases were determined from billing records and evaluated with chart review. Primary outcome was the rate of postinjection acute endophthalmitis. Secondary outcomes were visual acuity and microbial spectrum.
Results: A total of 243 754 intravitreal 0.5 mg ranibizumab injections (165 347 conventional and 78 407 prefilled) were administered to 43 132 unique patients during the study period. In the conventional ranibizumab group, a total of 43 cases of suspected endophthalmitis occurred (0.026%; 1 in 3845 injections) and 22 cases of culture-positive endophthalmitis occurred (0.013%; 1 in 7516 injections). In the prefilled ranibizumab group, 12 cases of suspected endophthalmitis occurred (0.015%; 1 in 6534 injections) and 2 cases of culture-positive endophthalmitis occurred (0.0026%; 1 in 39 204 injections). Prefilled syringes were associated with a trend toward decreased risk of suspected endophthalmitis (odds ratio 0.59; 95% confidence interval 0.31-1.12; P = .10) and a statistically significant decreased risk of culture-positive endophthalmitis (odds ratio 0.19; 95% confidence interval 0.045-0.82; P = .025). Average logMAR vision loss at final follow-up was significantly worse for eyes that developed endophthalmitis from the conventional ranibizumab preparation compared to the prefilled syringe group (4.45 lines lost from baseline acuity vs 0.38 lines lost; P = .0062). Oral-associated flora was found in 27.3% (6/22) of conventional ranibizumab culture-positive endophthalmitis cases (3 cases of Streptococcus viridans, 3 cases of Enterococcus faecalis) compared to 0 cases in the prefilled ranibizumab group.
Conclusion: In a large, multicenter, retrospective study the use of prefilled syringes during intravitreal injection of ranibizumab was associated with a reduced rate of culture-positive endophthalmitis, including from oral flora, as well as with improved visual acuity outcomes.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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