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Annika G. Samuelson, Ankur Nahar, Samir N Patel, Raziyeh Mahmoudzadeh, Mirataollah Salabati, JOHN W HINKLE, Rebecca Russ Soares, Ajay E. Kuriyan, Sunir Garg; Clinical Outcomes of Patients with Endophthalmitis after Dexamethasone Intravitreal Implant. Invest. Ophthalmol. Vis. Sci. 2022;63(7):4299.
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© ARVO (1962-2015); The Authors (2016-present)
To report a series of endophthalmitis cases associated with intravitreal dexamethasone implant injections in a single practice and discuss the clinic findings and visual outcomes associated with each case.
This retrospective consecutive case series identified all cases of endophthalmitis after intravitreal dexamethasone injection performed from January 1, 2014 to October 20, 2020 using the Wills Eye Hospital / MidAtlantic Retina billing record database. Each case was reviewed to confirm diagnosis of endophthalmitis, demographic and clinical information, and microbiology. Data was analyzed using Excel (Microsoft Excel, Redmond, Washington, USA).
Five cases of endophthalmitis were identified from 3,925 intravitreal dexamethasone injections, resulting in an incidence of 0.13% (1 in 785 injections). Mean age was 82.3 years (range, 63 – 88 years) with a mean of 11.3 intravitreal dexamethasone injections performed (range, 2 – 30 injections) prior to developing endophthalmitis. Cases presented with endophthalmitis a mean (SD) of 3.6 (1.64) days after the causative injection. Three cases grew gram-positive organisms on culture, while the other two cases were culture negative. All five patients responded to a single intravitreal tap and injection of vancomycin and ceftazidime. Mean logMAR visual acuity was 0.44 (20/55) at the time of the causative injection, 2.22 (20/3319) at endophthalmitis presentation, 1.18 (20/303) at three month follow up, and 1.46 (20/577) at last recorded follow up.
Endophthalmitis following intravitreal steroid injections may occur more frequently than after other intravitreal injections. Endophthalmitis following intravitreal dexamethasone implant injection remains an uncommon event. Eyes responded to treatment with intravitreal antibiotics, however the visual outcomes are variable.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
Clinical Presentation and Outcomes of Patients with Endophthalmitis after Dexamethasone Intravitreal Implant
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