Endophthalmitis Risks and Rates Reported at ARVO 2026

Presenters at ARVO 2026 expand upon the understanding of endophthalmitis and its association with ocular surgeries and intravitreal injections. All rates were below 1% of cases, though notable differences were found between procedures. Photo: Joseph Sowka, OD. Click image to enlarge. Although rare, inflammation of the intraocular tissues can be a serious complication leading to vision loss. During ARVO’s annual meeting yesterday morning, two studies addressing the burden of this type of infection were presented to attendees.In one study, researchers discovered that patients undergoing routine cataract surgery had the lowest risk of endophthalmitis, while patients receiving a secondary IOL had the highest risk.1 Conducted by a team from Bascom Palmer Eye Institute in Miami, this study used electronic health data along with CPT and ICD-10 codes to determine which ocular surgeries were at a higher risk for endophthalmitis. Data were sampled from 2005 to 2025.After analyzing the data, researchers identified 1,080,935 ocular surgeries for their study. Overall, the incidence of endophthalmitis in this population was one in every 1,040 surgeries (0.096%). The risk of endophthalmitis following ocular surgery was calculated for eight commonly performed procedures. Here are the results: routine cataract surgery (0.054%, one in 1861)trabeculectomy (0.062%, or one in 1607)combined cataract surgery with MIGS (0.068%, one in 1572)complex cataract surgery (0.106%; one in 941)corneal transplantation surgery (0.107%; one in 937)glaucoma drainage implants (0.117%; one in 855)retinal detachment surgery (0.175%; one in 570)secondary IOL implantation (0.520%; one in 192)Additionally, the presentation offered insight into the relative risk of endophthalmitis between routine cataract surgery and other procedures. The relative risk was similarly low between routine cataract surgery, combined cataract surgery with MIGS and trabeculectomy. This was inversely reported for other procedures, with higher relative risk in complex cataract surgery, glaucoma drainage implants, corneal transplantation surgery, retinal detachment surgery and secondary IOL implantation.In the second study, lower incidence rates of endophthalmitis were reported for patients administered intravitreal injections with prefilled syringes compared to vials.2 The presentation highlighted a higher risk of infection in patients administered corticosteroids compared to anti-VEGF treatments and pegcetacoplan.“In this large single-center cohort of more than 430,000 injections, endophthalmitis rates remain very low across all intravitreal therapies,” the researchers noted in their ARVO abstract. “These findings reinforce the overall safety of intravitreal injections, but preparation type and agent class deserve further study.”Over a five-year study period, 435,092 intravitreal injections were performed at a single eye care practice. A total of 185 cases of endophthalmitis were reported. The rate of infection was calculated for several drugs under three agent classes (anti-VEGF, pegcetacoplan and corticosteroids) and two preparation types (prefilled sterile syringes and vials).Some of the lowest infection rates were reported in the anti-VEGF class. Ranibizumab 0.5mg and 0.3mg had the lowest rate (0.0142%), while the aflibercept 8mg vial had the highest rate (0.0849%). Here are the results from lowest to highest:ranibizumab 0.5mg and 0.3mg (0.0142%)bevacizumab (0.0297%)aflibercept 2mg PFS (0.0398%)aflibercept 2mg vial (0.0401%)faricimab vial (0.041%)faricimab PFS (0.0411%)brolucizumab-dbll (0.0695%)aflibercept 8mg vial (0.0849%)Pegcetacoplan also showed a lower infection rate compared to other intravitreal injections, with a rate of 0.0304%.Compared to the observed anti-VEGF and pegcetacoplan results, corticosteroids had a significantly higher rate of endophthalmitis. Dexamethasone intravitreal implants had a rate of 0.1335% and triamcinolone acetonide had a rate of 0.5513%.When comparing the preparation types, researchers found a significantly lower rate of infection when using prefilled syringes compared to vials (0.0374% vs. 0.0561%).The results from both studies highlight the risk and rates of endophthalmitis following a myriad of eye care treatments. This work reflects the community ARVO fosters, which includes scientists and eye care experts “who advance research worldwide to understand the visual system and prevent, treat and cure its disorders.” Original abstracts ©2026 Association for Research in Vision and Ophthalmology. Click here for the first source and here for the second. 1. Zhang C, Rohowetz LJ, Yannuzzi NA, et al. Risk of acute-onset postoperative endophthalmitis following ophthalmologic surgery. ARVO 2026 annual meeting.2. Miller Z, Durny C, Hensley S, et al. Intravitreal pharmaceutical type usage and rates of endophthalmitis following intravitreal injection. ARVO 2026 annual meeting. 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.