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D. Mezad Koursh, M. Goldstein, A. Loewenstein, A. Barak; Clinical Characteristics of Endophthalmitis Following an Injection of Intravitreal Anti-Vascular Endothelial Growth Factor. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6042.
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To describe the clinical characteristics and management of patients with bacterial endophthalmitis following an intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection.
Retrospective chart review of all patients admitted with suspected endophthalmitis during 2006-2008.
14 cases of suspected endophthalmitis were reviewed. Endophthalmitis was verified by positive gram stain and culture in nine eyes.The mean pre-injection visual acuity (VA) of the nine eyes was 0.02 ± 0.021 (decimal VA scale) and dropped to 0.01667 ± 0.02449 diopters in the endophthalmitic eyes. Nine culture positive patients presented with reduced VA; seven also had ocular pain. The clinical presentation of culture negative cases was milder. Initial treatment was administered without delay and consisted of vitreous tap and intravitreal antibiotics injection (IVAI) in five cases, and pars plana vitrectomy with IVAI in the other four cases. The vitreous tap failed in one case. Seven patients underwent a second procedure and two underwent a third procedure. The mean post-treatment VA in all nine eyes improved significantly (to 0.19± 0.24, P = 0.0071). Five patients had major complications (e.g., retinal detachment, phacolytic glaucoma, recurrent endophthalmitis).
Acute endophthalmitis following anti-VEGF injection appears within days and can result in severe loss of vision if not treated promptly. In our serious the clinical and prognostic characteristics were considerably different between culture positive endophthalmitis cases and culture negative cases.
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