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Jordan Burnham, Sarah Duhon, Ching Jygh Chen, Heather Hancock; Endophthalmitis after intravitreal injections, a retrospective study. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3861.
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Determine the time from receiving an intravitreal injection until first presentation of endophthalmitis
Using CBT codes, we located every patient who has received the diagnosis of Endophthalmitis from July 2012 through August 2013. Patients were then screened and divided based on the etiology of their endophthalmitis (endogenous vs intravitreal injection vs post surgery vs other) and only the patients whose endophthalmitis was determined to be from intravitreal injections were included in the study. We recorded the date the patient received the injection, the type of medicine injected, presenting symptoms, microbial culture results, and the date of first presentation of symptoms after the injection.
11 patients were identified to have received the diagnosis of endophthalmitis after intravitreal injection from July 2012 to August 2013. Of these 11, 7 of the patients presented with their initial symptoms 3 days or less from the time of their injection. Over half of those patients (4/7) presented the next day after their injection. Four patients had positive intravitreal cultures (Staphylococcus coagulase negative (A) in three patients, Streptococcus viridans group (A) in one patient). Three patients received a combination of Eyelea and Triessence, five patients received only Avastin only, one patient received Ozurdex only, and one received Eylea only. Every patient complained of decreased vision and eye pain. 3 of the patients who presented greater than 3 days from their injection had received Avastin only and one had received Ozurdex.
Endophthalmitis is a rare, but potentially vision threatening infection. Early diagnosis and treatment is critical to prevent long term complications and blindness. Our study includes a small study group and microbial cultures were negative in 7 patients so we can not definitively say if these patients had Endophthalmitis or severe ocular inflammation. However, some important clinical results have been revealed. Patients who received Avastin or Ozurdex only injections (6/11) had the longest time between injection and presentation (3-13 days). Patients who received Eylea, Triessence, or combination injections (5/11) all presented with symptoms in 3 days or less. These results suggest that early patient follow up, perhaps within 3 days of receiving an intravitreal injection, is vital for early diagnosing and management of endophthalmitis.
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