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Justin John Arnett, Denise S Gallagher, Joseph Martel; Relative Quiescence of Exudative Maculopathy Following Resolution of Post-Injection Endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1467.
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Compare exudative maculopathy activity in patients receiving anti-VEGF therapy prior to and after post-injection endophthalmitis in exudative age-related macular degeneration (AMD).
Retrospective review of University of Pittsburgh Medical Center medical records from 2010-2017 of patients diagnosed with endophthalmitis and exudative AMD. 9 AMD patients receiving anti-VEGF therapy (either bevacizumab, ranibizumab, or aflibercept) developed post-injection endophthalmitis. The anti-VEGF treatment burden and choroidal neovascularization (CNV) activity, as identified by clinical examination and optical coherence tomography (OCT), were noted prior to and at specified time points following post-injection endophthalmitis.
Mean time from sentinel anti-VEGF injection to endophthalmitis presentation was 3.3 days (range: 1-7 days). Patients were immediately treated with intravitreal vancomycin in combination with either ceftazidime (7/9 patients) or amikacin (2/9 patients). 7/9 patients were additionally treated with intravitreal triamcinolone, and 4/9 patients underwent pars plana vitrectomy surgery. 3/9 patients exhibited positive vitreous cultures. Two patients were excluded from our analysis- one who exhibited C. Perfringens panophthalmitis with orbital extension requiring prompt enucleation, and another who developed poor vision from advanced optic neuropathy negating the need to resume anti-VEGF therapy. Mean follow-up time of the remaining 7 patients was 9.1 months (range: 1-16 months). Prior to endophthalmitis, patients were receiving anti-VEGF injections at a mean rate of 9/year (range: 6-12/year). Following endopthalmitis resolution, 4 patients exhibited quiescence of exudative maculopathy, negating the need to restart anti-VEGF therapy. The remaining 3 patients exhibited a reduction of exudative maculopathy activity and required 65.6% fewer anti-VEGF injections in their first year post-endophthalmitis compared to prior.
Post-injection endophthalmitis resolution was associated with a reduction or cessation of CNV activity in exudative AMD, resulting in a reduction in the frequency of anti-VEGF therapy to control exudative maculopathy. Some patients had long-term quiescence of exudative maculopathy. Further study is warranted to elucidate the etiology of relative CNV quiescence after resolution of endophthalmitis.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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