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Kamal Kishore, Bharti Kashyap, Anthony Ekong; Differentiation of culture positive endophthalmitis from non-infectious endophthalmitis following intravitreal anti-VEGF injections. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1103.
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To analyze clinical findings at presentation in culture positive and culture negative eyes suspected of acute endophthalmitis following intravitreal anti-VEGF injections.
Retrospective chart review of 10 eyes of 10 patients suspected of acute endophtalmitis following intravitreal injection of either Avastin or Lucentis. Patient's age, time to presentation, presenting VA, pain score, severity of conjunctival congestion, corneal edema, hypopyon, retinal hemorrhages were compared between culture positive (CP, n= 4, all after Avastin) and culture negative (CN, n= 6, 5 after Avastin and one after Lucentis) eyes.
Hypopyon was noted in 3/4 CP, and 0/6 CN eyes, retinal hemorrhages in 3/4 CP and 0/6 CN eyes. Both hypopyon and retinal hemorrhages had specificity of 100%, but sensitivity of 75% each. However, using OR criteria, patients with either hypopyon or retinal hemorrhages had 100% sensitivity and specificity for being culture positive. Patient age (years) [Mean 85 CP, 78.8 CN, p=0.3], Time to presentation (days) [Mean 5.75 CP, 5.1 CN, p=0.87], logMAR VA at presentation [Mean 1.6 CP, 1.4 CN, p=0.28], pain score [Mean 2 CP, 1 CN, p=0.2], were not statistically significant between the two groups. Conjunctival congestion (Mean 3 CP, 0.5 CN, p=0.00038) was more severe in CP group. All eyes had varying degree of corneal edema at presentation. Cultures revealed S aureus (2), coagulase negative Staph (1) and Staph capitis (1) eye. All CN eyes responded well to treatment, 3 CP eyes responded well to initial tap/inject procedure, one required a PPV 4 days after tap/inject. One CP eye treated with tap/inject alone developed retinal detachment which was repaired by PPV, SB and silcone oil injection. One CN eye developed recurrent inflammation after subsequent anti-VEGF injections.
Hypopyon and retina hemorrahges were specific for culture positive endophthalmitis following intravitreal anti-VEGF injections. Culture positive eyes exhibited more severe conjunctival congestion compared to culture negative eyes.
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