Suspected bacterial endophthalmitis following intravitreal anti-VEGF injection: case series and literature review.
OBJECTIVE
To report an up-to-date overview of all patients reported in the literature with suspected bacterial endophthalmitis following anti-VEGF injection. Secondly, to identify specific symptoms and signs to differentiate between infectious and noninfectious endophthalmitis.


METHODS
A Pubmed search retrieved 12 retrospective case series which had included a total of 118 patients with suspected bacterial endophthalmitis after anti-VEGF injection. Data of 15 patients from the Rotterdam Eye Hospital were added. Patients were divided into three groups: those who did not receive intravitreal antibiotics (group A), patients who received intravitreal antibiotics with biopsy-negative cultures (group B) and those with biopsy-positive cultures (group C).


RESULTS
The median time between anti-VEGF injection and presentation with suspected bacterial endophthalmitis was 1 day in group A compared to 3 days in groups B and C. At presentation, patients of group A had a better median visual acuity (logMAR 1.0) compared to those in groups B and C (logMAR 2.1 and 2.5, respectively).


CONCLUSIONS
This study suggests that patients presenting with a visual acuity of 20/200 (logMAR 1.0) or less and later than 24 h after injection are more likely to have bacterial endophthalmitis. To prevent undertreatment in these patients, the threshold to proceed to vitreous biopsy and empirical intravitreous antibiotics should be low.
Rotterdam Eye Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands. n.hoevenaars @ oogziekenhuis.nl
N E D
NE
Hoevenaars
D
D
Gans
T
T
Missotten
J
J
van Rooij
E
E
Lesaffre
J C
JC
van Meurs
D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D016208:Databases, Factual; D009877:Endophthalmitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D058449:Intravitreal Injections; D012189:Retrospective Studies; D013997:Time Factors; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity / Q000502:physiology
D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A