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Delayed endophthalmitis can occur weeks after intravitreal (IVT) dexamethasone implant (Ozurdex) injections. This rare complication requires sustained suspicion for prompt diagnosis and treatment.

Keywords:
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Area of Science:

  • Ophthalmology
  • Infectious Diseases

Background:

  • Intravitreal sustained-release dexamethasone implants (Ozurdex) are used for various ocular conditions.
  • Post-injection endophthalmitis is a known complication, typically with earlier onset.

Purpose of the Study:

  • To report cases of acute endophthalmitis with unusually delayed onset following intravitreal dexamethasone implantation.
  • To highlight the clinical challenge posed by late-presenting endophthalmitis after Ozurdex.

Main Methods:

  • Retrospective review of 3 patients diagnosed with endophthalmitis.
  • Delayed onset was noted at 16, 18, and 35 days post-dexamethasone implantation.
  • Treatment included diagnostic taps, intravitreal antibiotics, and pars plana vitrectomy without implant removal.

Main Results:

  • All cultures were positive, identifying Staphylococcus aureus, Staphylococcus epidermidis, and Granulicatella adiacens.
  • Presenting visual acuities were severely impaired (counting fingers to hand motions).
  • Final visual acuities varied, with outcomes of 20/60, 20/100, and hand motions only.

Conclusions:

  • Delayed-onset acute endophthalmitis is a significant concern after dexamethasone implantation.
  • Clinicians must maintain a high index of suspicion for endophthalmitis, even weeks after the injection.
  • This condition presents a diagnostic and therapeutic challenge due to its late presentation.