Endophthalmitis after intravitreal injections. Incidence, management and prognosis

Tarrago, Ricardo; Olea, J.L.; Ramírez, Carolina; Escudero, L.

doi:10.1016/j.oftale.2016.09.019

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…Intravitreal injections are the biggest treatment change in the past 10 years for age-related macular degeneration (AMD) and diabetic macular oedema (DMO). The incidence rates of POE vary between 0.038 and 0.053 11 12. In the EVS, patients were excluded based on pre-existing visual impairment secondary to other ocular conditions so benefits of contemporary early vitrectomy surgery in patients with POE with AMD and DMO cases remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Vitrectomy for endophthalmitis: 5-year study of outcomes and complications

et al. 2020

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Background/AimsTo analyse the complications and outcomes of vitrectomy surgery for endophthalmitis.MethodsThis was a retrospective case series. All cases that underwent 23-gauge vitrectomy surgery for endophthalmitis at a tertiary centre between 1 February 2013 and 1 February 2018 were included. Main outcome measures were as follows: visual acuity (VA) at final visit and post-vitrectomy complications.Results33 patients were included in the study with 20 men and 13 women, average age 63 years. Main post-surgical causes for endophthalmitis included phacoemulsification (n=9), trabeculectomy (n=5), intravitreal injection (n=5), corneal graft (n=4), vitreoretinal surgery (n=3) and endogenous endophthalmitis (n=6). Average follow-up was 18 months (SD 14). 21/33 (64%) patients had baseline perception of light VA. Analysis of exogenous endophthalmitis cases only demonstrated: mean LogMAR VA improved significantly from 2.68 to 1.66 (p=0.001). At final follow-up, 12% had VA of 6/12 or better, and 28% had VA of 6/36 or better. Vitrectomy within 7 days resulted in improved final VA outcomes (1.49 vs 2.16 LogMAR, p=0.032). Complications included retinal detachment (24.2%), macular hole (3%), hypotony (6%), suprachoroidal haemorrhage (3%) and enucleation/evisceration (6%).ConclusionVitrectomy for endophthalmitis leads to VA gains in some cases. Surgical outcomes may be improved with early vitrectomy performed within 7 days of the initial event for exogenous endophthalmitis. Patients should be advised of the potential risk of severe complications with/and without surgery.

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Section: Discussionmentioning

confidence: 99%

Vitrectomy for endophthalmitis: 5-year study of outcomes and complications

et al. 2020

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“…The white infiltrate at the injection site with surrounding conjunctival inflammation and delayed onset of pain were suggestive of bacterial infection in this patient. Because S. Epidermidis is a leading cause of endophthalmitis [ 4 , 10 ], we considered that as a likely etiology and prescribed topical ciprofloxacin 0.3% every 2 h. There was concern the patient might develop endophthalmitis through the vitreous wick that can occur after IVI or infectious tenonitis or scleritis, but the patient improved quickly. This case illustrates the importance of examination of delayed ocular redness and pain after IVI to ensure accurate diagnosis and appropriate management.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Acute Bacterial Tenonitis and Conjunctivitis following Intravitreal Injection

Huang¹,

Edwards²

2021

Case Rep Ophthalmol

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A 73-year-old man presented 3 days after intravitreal injection (IVI) with bevacizumab for treatment of neovascular age-related macular degeneration with pain and redness around the injection site. Examination showed conjunctival edema and injection around the injection site and a central infiltrate at the injection site consistent with infection of Tenon’s capsule and the conjunctiva. Infection of a vitreous wick was considered, but vitreous inflammation was not present. Acute bacterial tenonitis and conjunctivitis were diagnosed, and the patient was prescribed topical antibiotic drops. The patient’s symptoms were resolved within 48 h following the use of topical antibiotic drops, so a culture was not performed. The patient did not develop endophthalmitis. To our knowledge, this is the first reported case of acute bacterial tenonitis and conjunctivitis of the injection site following IVI. Even with the use of betadine, infection of Tenon’s capsule and the conjunctiva may occur after IVI and must be differentiated from other causes of postinjection ocular redness such as chemical irritation of the ocular surface, corneal abrasions, and endophthalmitis.

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“…Exudative/wet age-related macular degeneration (AMD) and diabetic macular oedema (DMO) are two leading causes of sight loss in the UK and these conditions may involve monthly eye injections into the vitreous jelly/humour "intravitreal injections." With the increasing numbers of invasive eye procedures, the frequency of postoperative endophthalmitis (POE) though rare is increasing 1,2 .…”

Section: Introductionmentioning

confidence: 99%

A Randomised Controlled Trial of Early Vitrectomy and Intravitreal Antibiotics for Post-operative Exogenous Endophthalmitis (EVIAN study): study protocol for a feasibility trial

Muqit,

Pavesio,

Boston

et al. 2023

NIHR Open Res

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Postoperative bacterial endophthalmitis is an infection of the eye's internal tissues resulting from an intraocular procedure. The condition is uncommon but can cause severe and irreversible impairment of sight. Standard management involves administration of antibiotics with or without subsequent removal of the infected vitreous gel by vitrectomy surgery. Surgical intervention is typically reserved for infections that persist despite a period of medical management alone. We aim to determine whether outcomes can be improved by performing surgery without delay. To explore the feasibility of a definitive randomised controlled trial and to determine the number of participants required, we will conduct a multicentre feasibility trial. This trial will include 40 affected individuals, allocated randomly to either standard of care, being intravitreal antibiotic administration alone, or to early vitrectomy surgery in addition to antibiotic administration. We will determine the feasibility and size of a definitive trial by evaluating the participants and the outcomes for their sight. Research Ethics Committee approval (REC 20/WM/0264). Here we describe the trial protocol.

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Endophthalmitis after intravitreal injections. Incidence, management and prognosis

Cited by 6 publications

References 22 publications

Vitrectomy for endophthalmitis: 5-year study of outcomes and complications

Vitrectomy for endophthalmitis: 5-year study of outcomes and complications

Acute Bacterial Tenonitis and Conjunctivitis following Intravitreal Injection

A Randomised Controlled Trial of Early Vitrectomy and Intravitreal Antibiotics for Post-operative Exogenous Endophthalmitis (EVIAN study): study protocol for a feasibility trial

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