This paper describes the presentation and outcomes of patients who developed endophthalmitis after intravitreal injection with VEGF inhibitors.

Study design

Researchers retrospectively assessed patient presentation and compared the outcomes of patients treated with immediate tap and injection of intravitreal antibiotics (TAI) vs initial surgical pars plana vitrectomy (PPV). They also determined factors that predict BCVA at 6 months.

Outcomes

Of the 258,357 intravitreal injections administered during the 10-year study period, 40 (0.016%) resulted in endophthalmitis within 3 weeks of the injection. In total, 34 patients (85.0%) reported pain and 25 patients (62.5%) had hypopyon on initial examination.

Among the 24 culture-positive cases, 66.7% of the causative organisms were coagulase-negative Staphylococcus, followed by Streptococcus species (10.0%). A higher proportion of samples had positive cultures in the PPV group compared with the TAI group (90.9% vs 48.3%; P=0.03). At the 6-month follow-up, patients who had a positive culture for Streptococcus species had a significantly worse BCVA than those who had a positive culture for coagulase-negative Staphylococcus (P<0.0001).

The TAI and PPV groups had similar BCVA at 6 months. Younger age (<85 years) and lower IOP (≤25 mm Hg) at presentation predicted a BCVA of 20/400 or better after 6 months of treatment. Initial management (ie, TAI vs PPV), duration of symptoms, presence of pain, presence of hypopyon, presenting BCVA, and culture status (positive vs negative) did not predict visual outcomes at 6 months.

Limitations

The study is potentially limited by selection bias. Patients with less severe endophthalmitis may have received TAI, while patients with more severe disease may have received PPV.

Clinical significance

The TAI and PPV groups showed similar BCVA at the 6-month follow up. Younger age and lower IOP at presentation were associated with better visual outcomes at 6 months. These findings may aid the evaluation of patients suspected of having this complication.