{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:59:37Z","timestamp":1787313577810,"version":"build-2736575974"},"reference-count":40,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,4,6]],"date-time":"2025-04-06T00:00:00Z","timestamp":1743897600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Bacterial endophthalmitis is a rare but serious complication of intravitreal injections (IVIs). Prefilled syringes have been introduced to reduce contamination risk during drug preparation. However, whether they lower the incidence of bacterial endophthalmitis compared to vials remains unclear. Methods: This retrospective cohort study analyzed aflibercept IVIs performed at 17 clinical centers in Japan between 2015 and 2022. Patients aged \u226520 years who received aflibercept IVIs (vial or prefilled syringe) for age-related macular degeneration, diabetic macular edema, retinal vein occlusion, or myopic choroidal neovascularization were included. Bacterial endophthalmitis was diagnosed based on clinical signs (e.g., rapid vision loss, pain, hypopyon, vitreous opacity). Incidence rates were compared using Fisher\u2019s exact test. Results: Among 152,039 injections (43,684 prefilled syringes; 108,355 vials), 12 cases of bacterial endophthalmitis were identified (0.0046% vs. 0.0092%, p = 0.53). Poor visual outcomes were associated with Enterococcus faecalis, Streptococcus spp., and diabetes. Conclusions: Although incidence was lower in the prefilled syringe group, the difference was not statistically significant. Detecting a significant difference requires a larger sample. Further studies are needed to confirm the potential benefits of prefilled syringes in reducing endophthalmitis risk.<\/jats:p>","DOI":"10.3390\/jcm14072491","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T05:30:59Z","timestamp":1744003859000},"page":"2491","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Comparison of Endophthalmitis Rates Between Prefilled Syringes and Standard Vials in Aflibercept Intravitreal Injections: A Retrospective Study in Japan"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8963-8064","authenticated-orcid":false,"given":"Masakazu","family":"Morioka","sequence":"first","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0418-6829","authenticated-orcid":false,"given":"Yoshihiro","family":"Takamura","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeo","family":"Yoshida","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology, Kurume University School of Medicine, Kurume 830-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junya","family":"Mori","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology, Sapporo City General Hospital, Sapporo 060-8604, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoko","family":"Sawada","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology, Shiga University of Medical Science, Otsu 520-2192, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisashi","family":"Matsubara","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6458-539X","authenticated-orcid":false,"given":"Sentaro","family":"Kusuhara","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5421-8580","authenticated-orcid":false,"given":"Tomoya","family":"Murakami","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8576, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9350-6809","authenticated-orcid":false,"given":"Aki","family":"Kato","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8602, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Tabuchi","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Nagasato","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuo","family":"Ueda","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology, Nara Medical University, Kashihara 634-8522, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiko","family":"Shimura","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Tokyo 193-0998, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3601-8053","authenticated-orcid":false,"given":"Takao","family":"Hirano","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto 390-8621, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuya","family":"Jujo","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4813-672X","authenticated-orcid":false,"given":"Yoshinori","family":"Mitamura","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Nishigaki","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology, Aichi Medical University, Nagakute 480-1195, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kozo","family":"Harimoto","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology, National Defense Medical College, Tokorozawa 359-8513, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5608-0546","authenticated-orcid":false,"given":"Mariko","family":"Sasaki","sequence":"additional","affiliation":[{"name":"J-CREST (Japan Clinical REtina STudy Group), Kagoshima 890-8544, Japan"},{"name":"Department of Ophthalmology, Tachikawa Hospital, Tachikawa 190-8531, Japan"},{"name":"Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaru","family":"Inatani","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, 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