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Updated: Sep 14, 2025
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Published on: February 6, 2021
Delayed-onset Moraxella nonliquefaciens endophthalmitis following intravitreal injection
Paul S Micevych1, Monika Fleckenstein1, Paul S Bernstein1
1John A. Moran Eye Center, University of Utah, USA.
Purpose:
To report a case of Moraxella nonliquefaciens endophthalmitis presenting one month after intravitreal injection.
Observations:
An 84-year-old man presented to the retina clinic with vision loss, pain, and redness in his right eye 28 days after a routine intravitreal injection of faricimab for exudative age-related macular degeneration. The patient had a remote history of cataract surgery, rhegmatogenous retinal detachment repair, and scleral buckle explant for exposure 3 years prior. The patient was found to have endophthalmitis, characterized by a hypopyon and dense vitritis. Broad-spectrum intravitreal antimicrobials and dexamethasone were administered, and a vitreous tap returned sterile. The patient achieved initial quiescence, but he had two recurrences of inflammation in this eye over the next 4.5 months. The patient ultimately underwent pars plana vitrectomy, vitreous biopsy, intraocular lens explant, capsulectomy and repeat intravitreal antimicrobial injections for definitive treatment. Broad-range PCR testing detected Moraxella nonliquefaciens. Inflammation resolved after surgery without further recurrence in the subsequent 7-month post-operative period.
Conclusions And Importance:
Moraxella species have been implicated in cases of endophthalmitis associated with glaucoma filtering surgery and trauma, but this report details a delayed-onset Moraxella nonliquefaciens-associated endophthalmitis after intravitreal injection.
Insights
A rare case of Moraxella nonliquefaciens endophthalmitis occurred one month after an intravitreal injection. This delayed-onset infection required surgical intervention for resolution.
Area of Science:
- Ophthalmology
- Infectious Diseases
Background:
- Intravitreal injections are common treatments for retinal diseases like age-related macular degeneration.
- Endophthalmitis is a serious intraocular infection that can lead to vision loss.
Observation:
- An 84-year-old male developed endophthalmitis one month post-intravitreal injection of faricimab.
- Initial treatment with antimicrobials and steroids failed, leading to recurrent inflammation.
- The patient required pars plana vitrectomy and further interventions for definitive treatment.
Findings:
- Broad-range PCR detected Moraxella nonliquefaciens in the vitreous biopsy.
- This is a rare instance of delayed-onset endophthalmitis caused by this bacterium following an intravitreal injection.
Implications:
- Highlights the importance of considering rare pathogens in delayed post-injection endophthalmitis.
- Suggests potential for Moraxella nonliquefaciens to cause endophthalmitis even without typical risk factors like trauma or surgery.
- Emphasizes the need for vigilant monitoring and potentially aggressive management in refractory cases.
