title: MICROBIAL SPECTRUM AND OUTCOMES OF ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTION VERSUS PARS PLANA VITRECTOMY.
abstract: OBJECTIVE
  To compare infectious organisms and visual outcomes of endophthalmitis after intravitreal injection (IVI) with endophthalmitis after pars plana vitrectomy (PPV).
  
  
  METHODS
  Retrospective, comparative, consecutive case series of patients diagnosed with presumed infectious endophthalmitis after IVI of an anti-vascular endothelial growth factor medication or PPV between January 1, 2009, and October 1, 2012, from one center. Main outcome measures were infectious organism and final visual acuity.
  
  
  RESULTS
  Forty-four cases of presumed infectious endophthalmitis (17 culture positive) occurred after IVI and 19 cases (9 culture positive) occurred after PPV. Of note, 56.3% of culture-positive IVI cases were due to bacteria associated with oral flora, primarily Streptococcus species, compared with none in the PPV group (P = 0.01). There was a trend approaching significance for IVI patients to have lost ≥3 lines of visual acuity compared with PPV patients at final follow-up (P = 0.07). Within the IVI group, patients were more likely to have lost ≥6 lines of visual acuity at final follow-up when endophthalmitis was due to an organism associated with oral flora (P = 0.007).
  
  
  CONCLUSIONS
  Endophthalmitis after IVI has a higher likelihood of being due to oral flora compared with endophthalmitis after PPV. Among IVI patients, worse visual outcomes occurred when endophthalmitis was due to oral flora.
authors.affiliation: *The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; and †Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Sunir J
authors.initials: SJ
authors.lastname: Garg
authors.forename: Michael
authors.initials: M
authors.lastname: Dollin
authors.forename: Philip
authors.initials: P
authors.lastname: Storey
authors.forename: John D
authors.initials: JD
authors.lastname: Pitcher
authors.forename: Natalie Hsiao
authors.initials: NH
authors.lastname: Fang-Yen
authors.forename: James
authors.initials: J
authors.lastname: Vander
authors.forename: Jason
authors.initials: J
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000627:therapeutic use; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification*; D002442:Ceftazidime / Q000627:therapeutic use; D004338:Drug Combinations; D057915:Drug Substitution; D009877:Endophthalmitis / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D012164:Retinal Diseases / Q000628:therapy*; D012189:Retrospective Studies; D014640:Vancomycin / Q000627:therapeutic use; 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; D004338:Drug Combinations; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D014640:Vancomycin; D000583:Amikacin; D002442:Ceftazidime