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Endophthalmitis and safety in intravitreal treatments in Sweden: the Swedish macula register

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Session Details

Session Title: Inflammation in Ocular Infections

Session Date/Time: Wednesday 17/09/2014 | 08:00-09:30

Paper Time: 08:18

Venue: Capital Hall A

First Author: : I.Westborg SWEDEN

Co Author(s): :    S. Albrecht   E. Granstam   G. Bjärnhall   N. Karlsson     

Abstract Details


The Swedish Macula Register (SMR), a national quality register for treatment of age-related maculadegeneration (AMD) established in 2003 and web based 2008. Photodynamic therapy was followed initially and since 2007 are 99% intravitreal treatments (IVT). In 2013 were 34 eye clinics active in SMR and registered treatments and follow-up visits. Adverse events are registered in SMR. A survey of operative routines in intravitreal treatments in Sweden and reported cases of endophthalmitis has been conducted 2013.




SMR registers age, sex, duration of symptoms, visual acuity (ETDRS, Snellen and near vision), diagnosis, type of choroid neovascularization (CNV) and treatment. Follow-up visits registers visual acuity, treatment, reasons for no treatment and adverse events. SMR analyse results (improvement of vision in ETDRS letters or Snellen) related to age, gender, type of lesion, number and type of treatments per clinic/county. Adverse events are reported to the register. In December 31 2013 SMR includes 15 606 patients, 17 877 eyes, 235 508 visits and 108 073 treatments. Mean age for start of treatment is 79 years of age and 64 % of patients are female. December 2013 of all IVT for AMD are Ranibizumab 37,3% Bevicizumab and 26,9% Aflibercept 35,8% . Adverse events are registered and a comparison with Medical Products Agency - Sweden (MPA) of severe adverse events has been conducted. 2007- 2012. A survey of operative routines IVT has been sent to all eye clinics/branch receptions in Sweden treating wet AMD November 2013.


The survey was answered by 41 of 41 clinics. IVT are performed in operation theatre (93%) and sterile room in office (7%). Antibiotics are used on the day of injection in 39 clinics. Only two clinics do not give any antibiotics before or after IVT. Registered cases of postoperative endophthalmitis 2007-2012 were 23 cases. This means an incidence of 0,28 ‰ per intravitreal injection and 1,3 ‰ per patient. MPA has received 12 cases of endophthalmitis 2007-2012. SMR have five registered cases of endophthalmitis 2013 (incidence 0,19 ‰ per IVT and 0,55 ‰ per patient). All cases were women, mean age 84 (72-93). Ranibizumab in three cases and Bevicizumab in two cases. Mean number of injections was 9 (3-11). Operative routines for IVT included antibiotics for all patients. Antibiotics just before IVT were none at one clinic (1), tobramycin (2), chloramphenicol (1) and levofloxacin (1). Antibiotics directly after IVT were fucidin (3), levofloxacin (1) and no antibiotic one clinic. IVT was performed in operation theatre (4) and sterile room (1). All clinics are using draping and blepharostat. One patient has had additional IVT 3 months after reported endophthalmitis.


The number of patients, treatments and follow–up visits has increased every yearin the Macula Register. The incidence of endophthalmitis is low but increased 2007 to 2012; during 2013 the rate of endophthalmitis after IVT is stable. Intravitreal injections are performed in operation theatre in most eye clinics in Sweden. 95% of the eye clinics give antibiotics in conjunction with IVT. Choices of antibiotics differ in Sweden and some use antibiotics both before and after IVT. Only two clinics use no antibiotic at all. In 2014 SMR will start a register for endophthalmitis after IVT including all intravitreal treatments for AMD, retinal vein occlusions and diabetic macula oedema.

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