Early clinical characteristics of bacterial endophthalmitis in retinopathy of prematurity after intravitreal bevacizumab injection: A case report

Abstract

Abstract. Intravitreal bevacizumab injection (IVB) is emerging as a safe and effective therapy for retinopathy of prematurity (ROP); however, follow-up investigations after IVB have indicated that endophthalmitis, a rare and devastating complication, may develop. The present study reports a case of an infant with ROP who developed endophthalmitis after IVB infection. The infant was administered with an intravitreal injection of broad-spectrum antibiotics to treat the endophthalmitis. A favorable anatomic outcome was achieved after follow-up. From this case, it was discovered that the early clinical characteristics of endophthalmitis infection secondary to IVB in premature infants include: i) The clinical symptoms of endophthalmitis infection appearing as early as 3-5 days after IVB; ii) a white membranous plaque on the retina surface with an obscure circular boundary; iii) a plaque that enlarges to a gray flocculent mass and intrudes the vitreous body, where the hazing surrounds the lesion; and iv) conjunctival hyperemia and cornea edema in the anterior segment of the affected eye. This case also indicated that timely retinal screening with RetCam or a binocular ophthalmoscope 3-5 days after IVB may be effective for detecting early stage endophthalmitis in infants who are unable to complain of a loss of visual acuity. From the present case report, it is advisable that the same type of screening be performed 3-5 days after other types of eye surgery, such as cataract extraction surgery, to detect early stage endophthalmitis. Furthermore, the present case also revealed that an early intravitreal injection of broad-spectrum antibiotics may be an effective treatment for premature infants with bacterial endophthalmitis.

Anti-vascular Endothelial Growth Factor Treatment of Retinopathy of Prematurity: Efficacy, Safety, and Anatomical Outcomes

“…However, several studies have shown systemic suppression of VEGF and other growth factors after intravitreal anti-VEGF injection in neonatal infants [1314], raising concerns about neurological or developmental delay [15]. There have also been isolated reports of retinal detachment [161718] and endophthalmitis [19] following intravitreal injections.…”

Post-Ranibizumab injection endophthalmitis in aggressive posterior retinopathy of prematurity

“…Wang and Xiang used one-third of adult dosage in their case based on the approximation that a premature infant's eye is one-third of the volume of an adult eye. [3] Similar to Ranibizumab dosage, half of the adult dosage was used in our case (0.5 mg vancomycin, 1 mg ceftazidime, and 200 μg dexamethasone).…”

“…[2] To the best of our knowledge, only a single report exists on infectious endophthalmitis after anti-VEGF injection in ROP, which described the early clinical characteristics and benefit of early intravitreal antibiotic injection. [3] We here report the course of disease in a case of post-ranibizumab injection endophthalmitis in aggressive posterior ROP (APROP) disease and discuss the management approach.…”

A Deep Learning Framework for Identifying Zone I in RetCam Images

“…Retinopathy of prematurity (ROP) is a vascular proliferative, blindness-causing disease, and has become one of the worldwide causes of childhood blindness [1]- [5]. ROP is one of the most dangerous and serious complications of premature infants' eyes [6], which can be better prevented in countries with high or middle income.…”