Abstract
Purpose :
Intravitreal anti-VEGF injections (IVI) are the most common in-office procedure for retinal diseases. Endophthalmitis is the most feared complication after IVI. Studies suggest that the time elapsed between the causative procedure and diagnosis of endophthalmitis may affect visual potential, but studies investigating timing specifically in the setting IVI are limited. We compared the clinical and microbiological outcomes of endophthalmitis in the setting of early and late presentation after IVI.
Methods :
Endophthalmitis cases were identified using ICD-10 codes in 9 clinical practices between January 1, 2017 and October 31, 2021. Patients were defined as presenting early if the elapsed time between IVI and endophthalmitis diagnosis was less than 5 days. Those presenting 5 days or later were placed in the late presenting group. Relationships between elapsed time and visual acuity (VA, logMAR) at baseline, time of diagnosis, and follow-up were analyzed. Culture positivity rates and growth information were also compared between groups.
Results :
Among 102,906 IVI, there were 70 (0.07%) cases of endophthalmitis. Forty-one (58.6%) cases presented early and 29 (41.4%) presented late, with median elapsed time (days) of 3 (range 1-4) and 7 (range 5-28). The groups were matched in age, sex, laterality, and baseline VA. The late group had more cases attributable to aflibercept, but this difference was not significant (26.8% in early vs. 48.3% in late, p=0.08). Mean VA at diagnosis was significantly worse for the late group (1.6 in early vs. 2.0 in late, p=0.02). Early and late groups were followed for 2.2 years and 2.1 years, respectively. Mean VA at follow-up was worse for the late group, but the difference was not significant (1.1 for early vs. 1.5 for late, p=0.2). Culture positivity rates were similar between groups (50.0% in early vs. 47.4% in late). Unlike the early group, few cultures in the late group grew gram-negative bacteria (2 cases) and Staphylococcus aureus (2 cases). These patients all had hand motion or worse vision at follow-up.
Conclusions :
Compared to early presentation, late presentation for endophthalmitis after IVI is associated with significantly worse vision at time of diagnosis but there seems to be no significant difference in the long term. Though rare, bacteria with higher virulence may be implicated in late presentation and result in poor visual outcomes.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.