Delayed-Onset Endophthalmitis After Intravitreal Dexamethasone Implantation

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.