Delayed-Onset Endophthalmitis After Intravitreal Dexamethasone Implantation

Purpose: To present a series of cases of acute endophthalmitis after intravitreal (IVT) sustained-release dexamethasone implantation (Ozurdex) with an unusually delayed onset. Methods: A retrospective review was performed of 3 patients presenting to West Virginia University Eye Institute and diagnosed with acute endophthalmitis 16 days, 18 days, and 35 days after dexamethasone implantation. The presenting visual acuities (VAs) were counting fingers at face to hand motions (HM) only. Each patient had an aqueous or vitreous tap with injection of IVT antibiotics followed by pars plana vitrectomy. The dexamethasone implants were not removed. Results: All cultures returned positive, including Staphylococcus aureus, Staphylococcus epidermidis, and Granulicatella adiacens. The 3 patients' final VAs were 20/60, 20/100, and HM only, respectively. Conclusions: Delayed-onset acute endophthalmitis after dexamethasone implantation represents a clinical challenge, potentially occurring up to weeks after the injection. Sustained suspicion for endophthalmitis is warranted given that cases may present beyond what is typical for postinjection endophthalmitis.