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Peer-reviewedCC BY 4.0Graefe's Archive for Clinical and Experimental Ophthalmology

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

  • Daniel David1,2
  • Dinah Zur3,2
  • Amit Biran3,2
  • Sharon Braudo4
  • Koby Brosh4
  • Elad Moisseiev5,2
  • Shiri Shulman6,7
  • Yoreh Barak8,9
  • Rita Ehrlich10,2
  • Shalev Fried1,2
  • Alon Peled11,2
  • David Hauser12
4 more authors
  • Tareq Jaouni13
  • Eran Pras11,2
  • Hagay Hayat12
  • Gabriel Katz1,2
13 affiliations
  1. 1Department of Ophthalmology, Sheba Medical Center, Faculty of Medical and Health Sciences, Goldschleger Eye Institute, Tel Aviv University, Tel Aviv, Israel
  2. 2Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
  3. 3Division of Ophthalmology, Tel Aviv Medical Center, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
  4. 4Department of Ophthalmology, Shaare Zedek Medical Center, Faculty of medicine, Hebrew University of Jerusalem, Jerusalem, Israel
  5. 5Department of Ophthalmology, Faculty of Medical and Health Sciences, Meir Medical Center, Tel Aviv University, Tel Aviv, Israel
  6. 6Ophthalmology Institute, Assuta Medical Centers, Tel Aviv, Israel
  7. 7Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
  8. 8Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
  9. 9Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
  10. 10Wolfson Medical Center, Holon, Israel
  11. 11Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel, Affiliated to the Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
  12. 12Department of Ophthalmology, Faculty of Health Sciences, Barzilai Medical Center, Ben-Gurion University, Ashkelon, Be’er Sheba, Israel
  13. 13Department of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{david2026endophthalmitis,
  title = {{Endophthalmitis rates following intravitreal injection of aflibercept using a prefilled syringe – a multicenter study}},
  author = {Daniel David and Dinah Zur and Amit Biran and Sharon Braudo and Koby Brosh and Elad Moisseiev and Shiri Shulman and Yoreh Barak and Rita Ehrlich and Shalev Fried and Alon Peled and David Hauser and Tareq Jaouni and Eran Pras and Hagay Hayat and Gabriel Katz},
  journal = {Graefe's Archive for Clinical and Experimental Ophthalmology},
  year = {2026},
  month = may,
  doi = {10.1007/s00417-026-07285-2},
  url = {https://doi.org/10.1007/s00417-026-07285-2},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Endophthalmitis rates following intravitreal injection of aflibercept using a prefilled syringe – a multicenter study
AU  - Daniel David
AU  - Dinah Zur
AU  - Amit Biran
AU  - Sharon Braudo
AU  - Koby Brosh
AU  - Elad Moisseiev
AU  - Shiri Shulman
AU  - Yoreh Barak
AU  - Rita Ehrlich
AU  - Shalev Fried
AU  - Alon Peled
AU  - David Hauser
AU  - Tareq Jaouni
AU  - Eran Pras
AU  - Hagay Hayat
AU  - Gabriel Katz
PY  - 2026
DA  - 2026/05/29
JO  - Graefe's Archive for Clinical and Experimental Ophthalmology
DO  - 10.1007/s00417-026-07285-2
UR  - https://doi.org/10.1007/s00417-026-07285-2
AB  - 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.
SN  - 0721-832X
SN  - 1435-702X
ER  -