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Kunyong Xu, Eric K Chin, David RP Almeida; Endophthalmitis After Intravitreal Injection of Vascular Endothelial Growth Factor Inhibitors: Management & Visual Outcomes. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4425.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the presentation of patients with endophthalmitis following intravitreal injection with vascular endothelial growth factor (VEGF) inhibitors. To compare outcomes of immediate tap-and-injection of intravitreal antibiotics (TAI group) versus immediate surgical pars plana vitrectomy (PPV group). To analyze predictive factors of final visual outcomes.
Retrospective single-center non-randomized interventional study involving patients developing endophthalmitis after intravitreal injection of anti-VEGF agent over a 10-year period between 2006 and 2016. All patients received a vitreous biopsy sent for cultures prior to the initiation of treatment. Logistic regression analysis was undertaken to assess predictive factors associated with final visual acuity.
A total of 258,357 intravitreal injections were administered over the course of the 10-year period, of which 40 patients (0.016%) developed endophthalmitis, within 3 weeks post-injection. Thirty-four (85.0%) patients had pain and 25 (62.5%) cases had hypopyon on initial examination. Among 24 culture-positive cases, 66.7% of the causative organisms were coagulase-negative Staphylococcus, followed by Streptococcus species (10.0%). The best corrected visual acuity (BCVA, LogMAR) on final visit was significantly worse for patients who had a positive culture for Streptococcus species (4.3, SD = 1.0) compared to those who had a positive culture for coagulase-negative Staphylococcus (0.6, SD = 0.3) (p < 0.001). A higher proportion of samples were culture-positive in the PPV group (90.9% vs 48.3%, p=0.03), in comparison to the TAI group. There was no statistically significant difference in final BCVA between TAI and PPV groups. Younger age (<85 years old) and lower intraocular pressure (IOP, <=25 mmHg) at presentation were predictive of achieving a final BCVA of 20/400 or better after treatment. Initial management (TAI vs PPV), duration of symptoms, presence of pain, presence of hypopyon, presenting BCVA, and culture status were not predictive of final visual outcomes.
Endophthalmitis was most commonly culture positive after PPV. There was no significant difference in final BCVA between the TAI and PPV groups. Younger age and lower IOP at presentation were associated with better long-term visual outcomes.
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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