Intravitreous (IVT) injection is the fastest growing procedure in ophthalmology. The number of IVT injections performed in the United States, estimated from Medicare procedure codes, increased from fewer than 3000 injections per year in 1999 to more than 1 million injections in 2008, and the number of injections will continue to increase given the aging population and the expanding indications.1
Because of the potential for severe vision loss, endophthalmitis remains the most feared complication after IVT injection, with a reported incidence ranging from 0.02% to 0.2%.2 However, because many retinal conditions require long-term serial injections, the cumulative risk per treated patient is more significant. Furthermore, several recent outbreaks of endophthalmitis have occurred in cities across the United States owing to contaminated bevacizumab, which has raised further safety concerns regarding this procedure. With the rapid increase in injections, this subject merits further review and summative assessments of best practice.