[Unilateral acute endophthalmitis due to Staphylococcus epidermidis after simultaneous bilateral intravitreal...

To report a case of unilateral acute endophthalmitis due to Staphylococcus epidermidis after simultaneous bilateral intravitreal injection using the same ranibizumab vial.

A 68-year-old phakic man had uneventful bilateral sequential ranibizumab intravitreal injection for bilateral neovascular age-related macular degeneration using the same vial. All of the vial contents (0.3 mL) were withdrawn through the filter needle attached to a 1-cc tuberculin syringe. Using the same syringe but separate injection needles, 0.05 mL was administrated to the right eye before 0.05 mL was injected into the left eye. Sterile gloves, drape, and eyelid speculum were used for each eye. Early Staphylococcus epidermidis postoperative endophthalmitis developed 3 days later in the right eye (injected first) with intense vitreous inflammation, limiting visual acuity to light perception. Management included intravitreal antibiotic agents and pars plana vitrectomy. The patient achieved an excellent visual outcome.

This case report demonstrates that bacterial endophthalmitis is a rare but potential complication of intravitreal anti-VEGF injection, that infection generally results from self-contamination of the patient from his or her own bacterial flora, and that simultaneous bilateral intravitreal injection should be avoided.