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Updated: Dec 17, 2025
Intravitreal Injection and Quantitation of Infection Parameters in a Mouse Model of Bacterial Endophthalmitis
Published on: February 6, 2021
Management and Visual Outcomes of Acute Bacterial Endophthalmitis Following Intravitreal Injection of Contaminated
Background And Objective:
Bevacizumab requires compounding for off-label intravitreal injection, thus creating a risk of possible contamination during preparation.
Patients And Methods:
This retrospective, consecutive case series from a single site included patients who developed culture-proven acute endophthalmitis after intravitreal injection with contaminated bevacizumab. All patients suspected of endophthalmitis had vitreous biopsy and microbial cultures prior to initiation of treatment and were managed with immediate tap and injection of antibiotics followed early by pars plana vitrectomy. Main outcome measures included best-corrected visual acuity (BCVA) at 3-month follow-up after treatment.
Results:
Twenty-four patients developed acute bacterial endophthalmitis following intravitreal injection of contaminated bevacizumab single-dose syringes in a single day. Twenty-three cases (95.8%) grew Streptococcus species and one (4.2%) grew Enterococcus species. Six cases (25.0%) had optic nerve atrophy, three (12.5%) developed retinal detachment, one (4.2%) had vitreous hemorrhage, and one (4.2%) had band keratopathy. At 3-month follow-up, compared to BCVA at the time of initial presentation, 11 patients (45.8%) had improved vision, eight (33.3%) had unchanged BCVA, and five (20.8%) had worse BCVA. However, when compared to BCVA prior to endophthalmitis (baseline), 22 cases (91.7%) had significantly worse BCVA at 3-month follow-up.
Conclusions:
Contamination of off-label bevacizumab poses devastating risk of endophthalmitis following intravitreal injection. Vigilance is needed to ensure all possible safeguards are in place to prevent contamination. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:346-352.].
Insights
Contaminated bevacizumab used for intravitreal injections led to acute bacterial endophthalmitis in 24 patients. Most cases had significantly worse vision post-treatment, highlighting contamination risks.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Retinal Surgery
Background:
- Bevacizumab compounding for intravitreal injection carries a risk of contamination.
- Off-label use of bevacizumab requires careful preparation to prevent adverse events.
Purpose of the Study:
- To report on acute bacterial endophthalmitis following intravitreal injection of contaminated bevacizumab.
- To assess visual outcomes in patients treated for endophthalmitis after bevacizumab contamination.
Main Methods:
- Retrospective case series of patients with culture-proven endophthalmitis post-intravitreal bevacizumab injection.
- Vitreous biopsy, microbial cultures, antibiotic treatment, and pars plana vitrectomy were performed.
- Best-corrected visual acuity (BCVA) was assessed at 3-month follow-up.
Main Results:
- Twenty-four patients developed acute bacterial endophthalmitis; 95.8% grew Streptococcus species.
- Common complications included optic nerve atrophy (25.0%) and retinal detachment (12.5%).
- At 3 months, 91.7% of patients had significantly worse BCVA compared to baseline.
Conclusions:
- Contamination of off-label bevacizumab for intravitreal injection presents a severe risk of endophthalmitis.
- Strict adherence to safety protocols is crucial to prevent contamination during bevacizumab preparation.
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