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Mohamed Haji, Erika Massicotte, Flavio Rezende; Acute endophthalmitis post-intravitreal bevacizumab injections wearing surgical masks. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1116.
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To evaluate the outcomes of acute endophthalmitis (AE) post-intravitreal injection of 1.25mg/0.05 ml bevacizumab (IVB) wearing surgical masks for diabetic macular edema (DME) or wet age-related macular degeneration (wAMD)
This is a retrospective, non-comparative, interventional case series. We reviewed medical records of patients treated for DME or wAMD with IVB from Jun/2010 to Dec/2012. Data collected included age, gender, laterality, number of injections, time from injection to AE diagnosis, microbiological results, initial visual acuity (VA) at AE diagnosis, and final VA. All IVB were done in an outpatient minor procedure room using sterile gloves, sterile lid speculum, 0.5% proparacain drops, 5% betadine drops, and a 1 ml syringe with a 30-gauge needle. Both surgeon and patients were wearing surgical masks. In the first 12 months, prophylactic polysporin drops 4 times/day were given for a week; in the last 18 months, no antibiotics (ATB) were given. Pars plana vitrectomy/vitreous tap and injection of vancomycin 1mg/0.1ml and ceftazidime 2.25mg/0.1ml were performed to treat all AE cases
Four patients with AE were identified out of 3088 injections of IVB (rate 0.13%). We had 3 females and 1 male, with age range of 68 to 97 years, 2 right eyes and 2 left, and a follow-up range of 3 to 20 months. Two patients were treated for DME and 2 for wAMD. The AE developed after a mean of 8 days (range 4 to 12 days) post-IVB and after a mean of 6 IVB (range 5 to 7 IVB). Three patients developed AE despite prophylactic ATB and 1 had AE with no ATB prophylaxis. Initial visual acuity ranged from 20/40 to 20/70 and at AE diagnosis from 20/50 to light perception. Final VA ranged from 20/60 to counting fingers with three out of 4 patients returning to their initial VA (+/- 2 lines).Two out of 4 cultures grew Staphylococcus epidermidis sensitive to vancomycin and 2 had no growth. Three out of 4 patients continued to receive IVB after AE treatment
The rate of AE post-IVB with both surgeon and patients wearing surgical masks is comparable to that reported in the literature but the microbiologic profile and outcomes seem to differ from reported cases of AE post-IVB without the use of masks and AE secondary to drug compounding contamination
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