Endophthalmitis after Intravitreal Injection of Vascular Endothelial Growth Factor Inhibitors: Management and Visual...

Area of Science:

• Ophthalmology
• Infectious Diseases
• Retinal Diseases

Background:

• Endophthalmitis is a rare but serious complication following intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents.
• Prompt diagnosis and management are crucial for preserving visual function.

Purpose of the Study:

• To describe the clinical presentation of endophthalmitis post-intravitreal anti-VEGF therapy.
• To compare the management outcomes of immediate tap and intravitreal antibiotics (TAI) versus pars plana vitrectomy (PPV).
• To identify predictive factors for visual outcomes at 6-month follow-up.

Main Methods:

• Retrospective, single-center, nonrandomized interventional study.
• Analysis of patients who developed endophthalmitis after intravitreal anti-VEGF injections between 2006 and 2016.
• Comparison of visual acuity outcomes between TAI and PPV treatment groups, with vitreous biopsy for cultures.

Main Results:

• Of 258,357 injections, 40 cases (0.016%) of endophthalmitis were identified.
• Coagulase-negative Staphylococcus was the most common pathogen (66.7% of culture-positive cases).
• No significant difference in best-corrected visual acuity (BCVA) at 6 months was found between TAI and PPV groups. Streptococcus species infection led to significantly worse BCVA.

Conclusions:

• Neither immediate tap and antibiotics nor pars plana vitrectomy showed a significant difference in visual outcomes for post-injection endophthalmitis.
• Younger age and lower intraocular pressure at presentation were associated with better visual prognoses.
• Identifying causative organisms is important, as Streptococcus species infections result in poorer visual outcomes.