Abstract
Purpose :
To describe the clinical management and outcomes in cases of presumed infectious endophthalmitis following intravitreal injection at a tertiary academic medical center.
Methods :
One hundred thirty-three eyes of 130 consecutive patients diagnosed with presumed infectious endophthalmitis over a nine-year period at the Duke Eye Center were identified and medical records were reviewed. Etiology of endophthalmitis, clinical presentation, management, microbiologic yield, visual outcomes, and complications were recorded.
Results :
Of 133 eyes, 23 eyes (17.3%) were diagnosed with presumed infectious endophthalmitis after intravitreal injection. Of these 23 eyes, 43.5% were male and mean age was 74 years (range 53-89 years). Intravitreal agents included aflibercept (60.9%), ranibizumab (17.4%), bevacizumab (13.0%), and preservative free triamcinolone acetate (8.7%).
Mean duration from injection to presentation with presumed endophthalmitis was 4.6 days (range 1-19 days). On presentation, 12 eyes (52.2%) underwent aqueous tap and 11 eyes (47.8%) underwent needle vitreous tap. Four of the 11 needle vitreous taps were “dry” with insufficient sample for microbiologic analysis. No eyes underwent initial pars plana vitrectomy (PPV). Positive cultures were obtained in 16.7% (2/12) of aqueous samples and 57.1% (4/7) of needle vitreous samples. Subsequent PPV was performed in 26.1% (6/23) of eyes after a mean follow-up of 64.5 days.
Mean presenting corrected visual acuity (VA) was 20/1145 and mean VA at the 6-month follow-up was 20/113 with an average improvement of 10 ETDRS lines. Eyes that underwent aqueous tap on presentation had significantly worse presenting VA (20/3508 vs 20/338, p = 0.013). Eyes that underwent subsequent PPV also had significantly worse presenting VA (20/7129 vs 20/601, p = 0.022) as well as worse VA at the 6-month follow-up (20/1002 vs 20/55, p = 0.00038). Eyes presenting with VA of hand motion at 1 foot (20/8000) or worse were more likely to undergo subsequent PPV (p = 0.02).
Conclusions :
Eyes with VA of hand motion at 1 foot (20/8000) or worse were more likely to undergo subsequent PPV. Earlier vitrectomy may be considered in these patients.
This is a 2020 ARVO Annual Meeting abstract.