title: A Large Outbreak of Fulminant Bacterial Endophthalmitis after Intravitreal Injection of Counterfeit Bevacizumab.
abstract: OBJECTIVE
  This study reports the findings in a large series of patients with acute bacterial endophthalmitis after intravitreal injection of bevacizumab (IVB) in two eye hospitals.
  
  
  METHODS
  Medical records were reviewed for patients who presented with acute fulminant endophthalmitis in one or two eyes following intravitreal injection of bevacizumab from two separate batches in two eye hospitals.
  
  
  RESULTS
  Twenty-eight eyes of 21 patients presented with acute endophthalmitis 12-48 hours after IVB injection. Cultures from the eyes and the vials were positive for E. coli and Citrobacter, each in one of the hospitals. All patients were initially treated with topical, intravitreal, and systemic antibiotics. Twenty-four eyes underwent pars plana vitrectomy. Best corrected visual acuity (BCVA) was 1.27 ± 0.89 logMAR before IVB injecti,on which decreased to 2.80 ± 0.45 LogMAR after presentation of endophthalmitis and 2.12 ± 0.97 logMAR three months after IVB injection. Final visual acuity was found to be no light perception in four eyes.
  
  
  CONCLUSIONS
  This large outbreak of E.coli and Citrobacter endophthalmitis occurred after intravitreal injection of counterfeit bevacizumab. Visual outcomes were very poor.
authors.affiliation: Ophthalmic Research Center, Department of Ophthalmology, Imam Hossein Medical Center, Shahid Beheshti Medical Sciences, Shahid Madani Ave., Tehran, Iran. entmort@hotmail.com.
authors.forename: Morteza
authors.initials: M
authors.lastname: Entezari
authors.affiliation: Ophthalmic Research Center, Department of Ophthalmology, Torfe Hospital, Shahid Beheshti Medical Sciences, Tehran, Iran.
authors.forename: Saeed
authors.initials: S
authors.lastname: Karimi
authors.affiliation: Ophthalmic Research Center, Department of Ophthalmology, Labbafinejad Hospital, Shahid Beheshti Medical Sciences, Tehran, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Ahmadieh
authors.affiliation: Ophthalmic Research Center, Department of Ophthalmology, Razi Hospital, Tehran, Iran.
authors.forename: Amir Hossein
authors.initials: AH
authors.lastname: Mahmoudi
authors.affiliation: Ophthalmic Research Center, Department of Ophthalmology, Razi Hospital, Tehran, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Parhizgar
authors.affiliation: Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Yaseri
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D000068258:Bevacizumab / Q000008:administration & dosage / Q000009:adverse effects*; D004196:Disease Outbreaks; D009877:Endophthalmitis / Q000453:epidemiology* / Q000209:etiology; D015818:Eye Infections, Bacterial / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012164:Retinal Diseases / Q000188:drug therapy*; D012189:Retrospective Studies; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab
keywords: Bevacizumab; Endophthalmitis; Outbreak