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Endophthalmitis After Dexamethasone Implant.

Maryam Eghtedari1, Zelia Chiu1, Fatemeh Shams1,2

  • 1Vitreo-Retinal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.

Clinical & Experimental Ophthalmology
|February 9, 2026
PubMed
Summary

The dexamethasone intravitreal implant has a 0.16% endophthalmitis rate, higher than other injections. This serious complication, often caused by Staphylococcus epidermidis, leads to poor visual outcomes and requires urgent intervention.

Keywords:
dexamethasone (DEX) implantendophthalmitisintravitreal injection

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Area of Science:

  • Ophthalmology
  • Retinal Diseases
  • Infectious Diseases

Background:

  • Dexamethasone intravitreal implants treat sight-threatening retinal disorders.
  • Endophthalmitis is a severe complication of intravitreal injections.
  • Emerging evidence suggests higher endophthalmitis rates with dexamethasone implants compared to other intravitreal injections.

Purpose of the Study:

  • To analyze the incidence and outcomes of dexamethasone implant-related endophthalmitis.
  • To determine the rate of infection following dexamethasone implant procedures.
  • To identify causative pathogens in endophthalmitis cases.

Main Methods:

  • Prospective data collection from the Victorian Endophthalmitis Registry (January 2018 - June 2024).
  • Analysis of Pharmaceutical Benefits Schedule Item Reports to determine implant usage.
  • Case identification and management at a state-wide tertiary eye hospital.

Main Results:

  • Fifteen cases of endophthalmitis occurred from 9457 implants, yielding an incidence rate of 0.16% (1 in 630).
  • Staphylococcus epidermidis was the most common pathogen (46.7%), with 86.7% of vitreous samples being culture-positive.
  • Twenty percent of affected eyes required enucleation, and the mean visual acuity in remaining eyes was poor (Snellen 6/27).

Conclusions:

  • Dexamethasone implant-related endophthalmitis occurs at a higher rate (0.16%) than previously reported for other intravitreal injections.
  • Infection rates and poor visual outcomes highlight the need for vigilance and prompt management.
  • Early diagnosis and intervention, including surgical treatment, are crucial for managing this complication.