A second occurrence of intravitreal injection-associated endophthalmitis 2 years apart

This case report describes a patient who developed a second episode of endophthalmitis in the same eye following intravitreal injections administered 2 years apart.

An 83-year-old pseudophakic male with a history of neovascular age-related macular degeneration and diabetes mellitus complained of decreased visual acuity and pain in the left eye 1 day after receiving intravitreal aflibercept 2 mg. Best-corrected visual acuity (BCVA) was light perception. The clinical examination revealed signs of endophthalmitis including fibrin and hypopyon while B-scan ultrasonography demonstrated vitreous opacities and membranes. The patient underwent vitreous tap and injection with intravitreal vancomycin, ceftazidime, and dexamethasone. Pars plana vitrectomy with posterior hyaloid detachment was performed the following day due to a relative lack of clinical improvement. Vitreous cultures ultimately demonstrated no growth and BCVA improved to baseline. Anti-VEGF therapy was resumed 3 months after the initial diagnosis of endophthalmitis. Two years later the patient presented with evidence of a second episode of endophthalmitis 4 days after receiving aflibercept 8 mg. Vitreous tap and injection was again performed and cultures revealed growth of Staphyloccoccus epidermidis. The patient demonstrated marked improvement with no evidence of residual inflammation at 2 weeks. Best-corrected visual acuity was 20/50 at 7-month follow-up examination.

Endophthalmitis is a rare complication of intravitreal injection. The current report describes a patient who developed a second occurrence of endophthalmitis associated with an intravitreal injection 2 years later.