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Farshad Abedi, Armand Michael Borovic, Ian Caithness Francis; Endophthalmitis after an intravitreal anti-vascular endothelial growth factor injection may unmask a masquerade - A patient with an ocular lymphoma . Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4173.
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© ARVO (1962-2015); The Authors (2016-present)
To report the unmasking of an intraocular Natural Killer/T-cell lymphoma in a patient with endophthalmitis following an intravitreal injection of bevacizumab
An 86 year old male was referred emergently to the Department of Ophthalmology with a two week history of purulent discharge from his left eye. He had received an intravitreal injection of bevacizumab in his left eye for diabetic maculopathy five weeks prior. His left visual acuity was no perception of light, with a purulent and hemoserous discharge from the eye and conjunctiva. The left globe and orbit were tense. Blood tests showed a mild neutrophilia. B scan ultrasound revealed diffuse hyperechoic material in the left vitreous. CT scan of the orbits reported left periorbital preseptal soft tissue swelling and stranding as well as postseptal and intraconal fat stranding and a heterogenous left globe, consistent with panophthalmitis. Intensive systemic and topical antibiotics were commenced. Culture of the left eye discharge grew Streptococcus pneumoniae. Left evisceration was performed 4 days after admission. Uveal tissue was sent for histopathology, which showed high grade extranodal natural killer T cell lymphoma. He was referred for hematological assessment.
This patient’s purportedly impaired ocular immune status, secondary to ocular lymphoma, may have been a predisposing factor for the development of endophthalmitis following intravitreal injection. Given the very low risk of endophthalmitis after intravitreal injections, clinicians should probably consider further investigations in such patients to exclude such possible predisposing etiologies.
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