Clinical characteristics of endophthalmitis after an injection of intravitreal antivascular endothelial growth factor.
OBJECTIVE
The purpose of this study was to describe the clinical characteristics and management of patients with bacterial endophthalmitis after an intravitreal antivascular endothelial growth factor injection.


METHODS
This is a retrospective chart review of all patients admitted with suspected endophthalmitis from 2006 to 2008.


RESULTS
Endophthalmitis was verified by positive Gram stain and culture in nine eyes. The mean preinjection visual acuity of the 9 eyes was 0.02 +/- 0.021 diopters (decimal visual acuity scale) and dropped to 0.01667 +/- 0.02449 diopters in the eyes with endophthalmitis. All nine patients presented with reduced visual acuity, of whom seven also had ocular pain. Initial treatment was administered without delay and consisted of vitreous tap and intravitreal antibiotics injection in five cases and pars plana vitrectomy with intravitreal antibiotics injection in the other four cases. Vitreous tap failed in one case. Seven patients underwent a second procedure and two underwent a third procedure. The mean posttreatment visual acuity in all 9 eyes improved significantly (0.19 +/- 0.24, P = 0.0071). Five patients had major complications (e.g., retinal detachment, phacolytic glaucoma, and recurrent endophthalmitis).


CONCLUSIONS
Acute endophthalmitis following anti-VEGF injection appears within days and can result in severe loss of vision if not treated promptly. In our series the clinical and prognostic characteristics were considerably different between culture positive endophthalmitis cases and culture negative cases.
Mezad-Koursh
Daphna
D
Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Goldstein
Michaella
M
Heilwail
Gad
G
Zayit-Soudry
Shiri
S
Loewenstein
Anat
A
Barak
Adiel
A
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D001419:Bacteria / Q000302:isolation & purification; D000068258:Bevacizumab; D009877:Endophthalmitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D014822:Vitreous Body / Q000382:microbiology
D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab