Endophthalmitis Rates Following Intravitreal Injection Remain Exceedingly Low

Endophthalmitis is a rare, debilitating ocular complication that can develop following intravitreal injection and should be managed with antibiotics with or without pars plana vitrectomy. Photo: Leo Skorin, OD. Click image to enlarge. Endophthalmitis caused by bacterial or fungal infections is potentially devastating to the eye. Fortunately, despite the huge volume of intravitreal injections performed over the last 20 years, it’s rarely observed in patients after a shot. Bascom Palmer Eye Institute has examined this specific issue in patients before. From 2005 to 2020, they reported low rates of complications following injection. Recently, researchers from the institution conducted a similar study examining rates of endophthalmitis between 2021 and 2024.In the study, published in Retina, researchers observed endophthalmitis rates, culture results and visual acuity outcomes of patients who received intravitreal injections.“The yearly incidence of endophthalmitis after intravitreal injection in the current study was low at 0.0087%,” said the authors of the paper. “This rate is also similar to previously reported rates, 0.013 to 0.014%, at Bascom Palmer Eye Institute between 2005 and 2020, suggesting that the use of newer agents introduced since this time period, namely faricimab and aflibercept 8mg, were not associated with a higher risk of endophthalmitis.”Researchers administered intravitreal injections into 115,367 eyes every year between 2021 and 2024, and only 10 presented with endophthalmitis. Vitreous cultures revealed five different growths in five infected eyes (Streptococcus mitis/oralis, Staphylococcus aureus, Granulicatella adiacens, Staphylococcus epidermis and Abiotrophia defectiva), but the cultures of the remaining five eyes were negative.Following treatment, researchers tested patients’ visual acuities. The average reported best corrected visual acuity was 20/526 Snellen, or 1.42 logMAR. Interestingly, one patient with endophthalmitis due to Staph. epidermidis presented with a visual acuity of 20/50 after treatment.As with many studies, researchers could not account for all limitations. During their examinations, they used visual acuity test results to account for the timing and severity of infection for each case. However, this isn’t perfect, and additional non-quantifiable factors could have impacted the results. Additionally, the location of the study caused limitations. Bascom Palmer is a large institution, but they had a small number of endophthalmitis cases, which could prevent researchers from observing meaningful differences between groups. Also, researchers used the same intravitreal injection protocol, which means differences in technique could not be reported.Click here for the journal source. Rohowetz LJ, Snow Z, Townsend JH, et al. Endophthalmitis associated with intravitreal injection: rates culture results, and visual acuity outcomes. Retina. April 16, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.