Disease Recurrence Following Endophthalmitis Associated with Intravitreal Injection

Abstract

Purpose : Though the use of intravitreal agents has revolutionized the treatment of exudative age related macular degeneration (AMD) and diabetic macular edema (DME), they can lead to complications, including infectious endophthalmitis. To better understand the effect of endophthalmitis on exudative AMD and to determine its influence on the need for future injections we performed a single center, retrospective study of subjects who developed endophthalmitis after intravitreal injection.

Methods : We searched the electronic medical record for all subjects from 2008 to 8/15/15 whose record included CPT and ICD-9 codes for both intravitreal injection and endophthalmitis. In addition, we examined the time to recurrence of intraretinal or subretinal fluid and/or hemorrhage after resolution of endophthalmitis in a subset of subjects with exudative AMD. We recorded the median number of injections required one and two years before and after the date of their infection.

Results : We identified 46,874 intravitreal injections performed at our institution during the study period. Eighteen eyes of 17 subjects presented with endophthalmitis causally related to injection. Six of these were referred following injections performed outside of our institution. Thirteen eyes had been treated for exudative AMD, 2 for DME, and 3 for edema secondary to vein occlusion. In 7 eyes treated for exudative AMD whose vision was hand motions or better after infection and for whom data were available, there was recurrence of retinal edema after the endophthalmitis event. The median number of days to recurrence after resolution of infection was 49 (range 20-104). Six eyes had injection data one year before and after infection and 4 eyes had two year data. A median of 10 (range 8-13) injections were required one year before and 21.5 (range 19-25) two years before infection. To control recurrent fluid, a median of 8 (range 4-12) injections were needed one year after and 16.5 (range 14-20) two years after infection. Though the sample size was small, there was a trend towards needing fewer injections two years after infection compared to before.

Conclusions : For some subjects who developed endophthalmitis after intravitreal injection, exudative AMD remained active or recurred, requiring reinstitution of intravitreal injection therapy. In these patients there may be a trend towards needing fewer injections in the long term after the infection has cleared.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.