title: Endophthalmitis following intravitreal injections.
abstract: BACKGROUND
  To report the clinical features, culture results, management and visual outcome of patients with endophthalmitis following intravitreal injections.
  
  
  METHODS
  Retrospective review of all patients with suspected endophthalmitis after intravitreal injections treated with intravitreal antibiotics (teicoplanin and ciprofloxacin) at a referral centre between January 2003 and December 2010.
  
  
  RESULTS
  Nineteen cases that had aqueous or vitreous biopsy were identified. Nine had negative culture. Ten had positive culture; Staphylococcus species in 4/10, Streptococcus species in 4/10, E. coli in 1/10 and gram-negative bacilli in 1/10. Symptoms developed within the first 48 hours in all. One of ten culture-positive cases had no pain on presentation, while 5/9 patients with negative culture reported pain. Initial treatment consisted of intravitreal antibiotics in all cases, 6/19 cases required a second intravitreal antibiotic injection, 4/19 underwent vitrectomy as secondary therapy. At the last follow up, 7/19 patients had visual acuity of 6/18 or better, 9/19 had visual acuity of 6/60 or worse.
  
  
  CONCLUSIONS
  The overall numbers of patients with endophthalmitis following intravitreal injections has risen dramatically over the past years. In contrast to earlier reports of multicentre studies, outcome of patients is relatively poor in the current treatment settings. We did not find clinical features useful in identifying cases with negative culture.
authors: Link 8z, St Paul's Eye Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
authors: Cristina
authors: C
authors: Irigoyen
authors: Kimia
authors: K
authors: Ziahosseini
authors: George
authors: G
authors: Morphis
authors: Theodor
authors: T
authors: Stappler
authors: Heinrich
authors: H
authors: Heimann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000382:microbiology; D001419:Bacteria / Q000302:isolation & purification; D002939:Ciprofloxacin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D009877:Endophthalmitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D005260:Female; D006801:Humans; D058449:Intravitreal Injections / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017334:Teicoplanin / Q000627:therapeutic use; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D014822:Vitreous Body / Q000382:microbiology
chemical_list: D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D002939:Ciprofloxacin; D017334:Teicoplanin; D014222:Triamcinolone Acetonide