July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
The utility of vitreous cultures in the management of endophthalmitis following intravitreal injection of anti-vascular endothelial growth factor agents
Author Affiliations & Notes
  • Samir N Patel
    Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Philip Storey
    Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Maitri Pancholy
    Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Anthony Obeid
    Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Turner D Wibbelsman
    Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Hannah Levin
    Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Jason Hsu
    Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Sunir Garg
    Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • James Dunn
    Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • James Vander
    Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Samir Patel, None; Philip Storey, None; Maitri Pancholy, None; Anthony Obeid, None; Turner Wibbelsman, None; Hannah Levin, None; Jason Hsu, None; Sunir Garg, None; James Dunn, None; James Vander, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 2022. doi:
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      Samir N Patel, Philip Storey, Maitri Pancholy, Anthony Obeid, Turner D Wibbelsman, Hannah Levin, Jason Hsu, Sunir Garg, James Dunn, James Vander; The utility of vitreous cultures in the management of endophthalmitis following intravitreal injection of anti-vascular endothelial growth factor agents. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2022.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To assess the utility of culture data in the management of endophthalmitis following intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents.

Methods : All patients who developed endophthalmitis after intravitreal injection of aflibercept, bevacizumab, or ranibizumab between 1/1/2016 and 5/31/2018 at a single institution were evaluated. The total number of eyes, injections, and endophthalmitis cases were determined from billing records and evaluated with chart review. A change in clinical management was defined as additional intravitreal antibiotic injection or pars plana vitrectomy. The main outcome measures were visual acuity and a change in clinical management within 1 week of initial endophthalmitis culture and treatment.

Results : 204,986 intravitreal injections of anti-VEGF agents were performed and 70 cases (0.0327%) of endophthalmitis were identified, 17 of which were culture-positive. A change in clinical management was initiated within 1 week of initial culture in 3/17 (18%) culture-positive cases compared to 3/50 (6%) culture-negative cases (p=0.143). Changes in clinical management for culture-positive cases were performed based on declining vision (2 cases) and worsening clinical exam (1 case). Changes in clinical management for culture-negative endophthalmitis cases were performed based on declining vision (1 case) and worsening clinical exam (2 cases) (Table 1). No additional interventions were initiated based on a positive-culture result. Comparing vision loss from baseline by culture result, at final follow up, patients with oral flora-associated culture-positive cases lost 17.5 lines, non-oral flora-associated culture-positive cases lost 9.8 lines, and culture negative cases lost 2.4 lines of vision (p<0.001) (Table 2).

Conclusions : Following endophthalmitis from intravitreal injection of anti-VEGF agents, vitreous culture data may help prognosticate visual outcomes but appear to have a limited effect on clinical management.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Table 1. Changes in management within 1 week of developing endophthalmitis after intravitreal injection of anti-VEGF agents

Table 1. Changes in management within 1 week of developing endophthalmitis after intravitreal injection of anti-VEGF agents

 

Table 2. Visual acuity outcomes of patients with culture positive and culture negative endophthalmitis after administration of intravitreal anti-VEGF injections

Table 2. Visual acuity outcomes of patients with culture positive and culture negative endophthalmitis after administration of intravitreal anti-VEGF injections

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