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Libing Kathy Dong, Ryan A Shields; Predictors of visual recovery after post-injection endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1350.
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Acute infectious endophthalmitis is a known complication following intravitreal injections, occurring at a rate of 0.016% to 0.056% per injection. Given their extensive and persistent use, we sought to evaluate factors associated with worse visual outcomes after post-injection endophthalmitis.
A retrospective, consecutive case series was conducted on patients treated for post-injection endophthalmitis at Associated Retinal Consultants (ARC) P.C. (Royal Oak, Michigan) from January 2013 thru December 2019.The main outcome measure was change in visual acuity before and after endophthalmitis. Univariate modeling was performed to assess factors associated with visual change.
One hundred and forty six patients were identified who developed post-injection endophthalmitis. The median age at presentation was 78.1 years. The most common indication for treatment was neovascular age-related macular degeneration in 101 patients (69%), followed by proliferative diabetic retinopathy/diabetic macular edema in 29 (20%). Ranibizumab was injected in 68 patients (47%), Aflibercept in 56 patients (38%), bevacizumab in 10 (6.8%), dexamethasone implant in 9 (6.2%), and the remaining 3 (2%) with combination therapy. The median number of injections prior to developing endophthalmitis was 22 (range 1 to 107). The mean time from injection to endophthalmitis development was 4.5 days (range 1 to 17). The vast majority of patients (139 of 146) were treated with an immediate vitreous biopsy and intravitreal antibiotics (TAI) while 7 (of 146) underwent an immediate vitrectomy. Biopsy cultures were obtained in all 146 patients with 56 cultures (39.5%) yielding growth. The mean follow-up time after endophthalmitis development was 839 days (range 34 to 2560). Mean initial logMAR visual acuity (VA) was 0.5 (Snellen 20/63), while mean final LogMAR VA was 0.92 (Snellen 20/166). Risk factors for vision loss after endophthalmitis included culture positivity (p = 0.017) and need for vitrectomy (p = 0.001). The cumulative number of injections (r = -0.007, p = 0.47) was not associated with significant vision loss after endophthalmitis (Figure 1).
Although frequently done at recurrent intervals, cumulative injections are not associated with worse visual outcomes following endophthalmitis. Factors that were associated with poor visual prognosis included the culture positivity and the need for a vitrectomy in the post infection period.
This is a 2021 ARVO Annual Meeting abstract.
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