Clinical Characteristics of Endophthalmitis After an Injection of Intravitreal Antivascular Endothelial Growth Factor

Abstract

Acute endophthalmitis following anti-VEGF injection appears within days and can result in severe loss of vision if not treated promptly. In our series the clinical and prognostic characteristics were considerably different between culture positive endophthalmitis cases and culture negative cases.

Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature

“…In one study the time of presentation, presence of pain, and the severity of clinical findings were helpful. 26 The symptoms began at an average of 2.55 days (range, 1-6 days) after injection in the endophthalmitis group and less than 1 day in the acute intraocular inflammation group. Seven of nine patients with endophthalmitis and two of five patients with acute intraocular inflammation had a painful eye on presentation.…”

“…26,27 Rhegmatogenous retinal detachment The overall incidence of rhegmatogenous retinal detachment (RRD) after intravitreal injection of anti-VEGF agents is low (0 to 0.67%). 25,29 In a study on Medicare database, the differences in rates of RRD and retinal tear were not statistically significant between eyes with intravitreal anti-VEGF injection and a matched control group.…”

The Role of Prophylactic Antibiotic Use in Prevention of Endophthalmitis Following Intravitreal Injection of Anti-Vascular Endothelial Growth Factor Agents: A Meta-Analysis

“…The only statistically significant variable they found to decrease the rate of endophthalmitis was the use of topical povidone-iodine to sterilize the ocular surface [2]. Both this study and the study by Mezad-Koursh et al did not examine the use of postinjection antibiotics as an independent variable; all patients in both groups routinely received antibiotics postinjection [2][3]. It has been shown that the use of povidone-iodine on the ocular surface is just as effective as a combination of preinjection antibiotic drops along with povidone-iodine, and most ophthalmologists therefore do not use any preinjection antibiotics [8].…”

“…Of the few cases of post-injection endophthalmitis reported in the literature, there is a significant percentage that had negative cultures (33% -70%) [1][2][3]6]. Of the cases in which cultures were positive, the most common organisms were coagulase-negative Staphylococcus spe-cies, Streptococcus species, followed by Bacillus cereus, and Enterococcus faecalis [1,2].…”

“…This rate varies based on the study, but ranges from 0.009% to 0.87%, and will continue to rise with the increasing use of these injections [1][2][3][4][5][6]. Although the incidence is low, endophthalmitis is a devastating complication, which may cause apoptosis of ganglion cells, bipolar cells and photoreceptors, lead to retinal detachments, and potentially cause severe and permanent loss of vision [2,7].…”