title: Vitreous hemorrhage as an early sign of acute bacterial endophthalmitis following intravitreal ranibizumab injection.
abstract: OBJECTIVE
  To report a case of acute bacterial endophthalmitis after antivascular endothelial growth factor injection with a rare presentation of vitreous hemorrhage.
  
  
  METHODS
  An 84-year-old woman presented with sudden painless vision loss in her left eye, 3 days after intravitreal ranibizumab injection for cystoid macular edema due to neovascular age-related macular degeneration. The patient was otherwise asymptomatic. Dense vitreous hemorrhage was observed. At follow-up the next day, the patient complained on severe left eye pain. After examination, acute endophthalmitis was diagnosed.
  
  
  RESULTS
  Intravitreal injection of vancomycin, ceftazidime and dexamethasone was performed. Vitreous and aqueous cultures grew Enterococcus faecalis. After treatment, the inflammation subsided but it took 3 months for the vitreous hemorrhage to totally resorb. Visual acuity was reduced to light perception.
  
  
  CONCLUSIONS
  Vitreous hemorrhage may be an atypical presentation of acute bacterial endophthalmitis occurring after intravitreal injection.
authors.affiliation: Department of Ophthalmology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel. Yishayweill@gmail.com.
authors.forename: Yishay
authors.identifier: http://orcid.org/0000-0003-4714-2594
authors.initials: Y
authors.lastname: Weill
authors.affiliation: Department of Ophthalmology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel.
authors.forename: Koby
authors.initials: K
authors.lastname: Brosh
authors.affiliation: Department of Ophthalmology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel.
authors.forename: Tamar
authors.initials: T
authors.lastname: Levi-Vineberg
authors.affiliation: Department of Ophthalmology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel.
authors.forename: Joel
authors.initials: J
authors.lastname: Hanhart
mesh_terms: D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D009877:Endophthalmitis / Q000175:diagnosis*; D013293:Enterococcus faecalis / Q000302:isolation & purification; D015818:Eye Infections, Bacterial / Q000150:complications*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications; D006801:Humans; D058449:Intravitreal Injections / Q000009:adverse effects*; D000069579:Ranibizumab / Q000008:administration & dosage; D014823:Vitreous Hemorrhage / Q000175:diagnosis*
chemical_list: D020533:Angiogenesis Inhibitors; D000069579:Ranibizumab
keywords: Antivascular endothelial growth factor; Endophthalmitis; Enterococcus faecalis; Intravitreal injection; Ranibizumab; Vitreous hemorrhage