Xu K, et al. - Researchers, herein, report the presenting features of patients developing endophthalmitis after intravitreal injection with vascular endothelial growth factor (VEGF) inhibitors. Moreover, they compared the outcomes of immediate tap and injection of intravitreal antibiotics (TAI) vs initial surgical pars plana vitrectomy (PPV) and, analyzed the predictive factors of visual outcomes at 6-month follow-up. TAI and PPV groups showed no significant difference in best-corrected visual acuity at 6-month follow-up. Data showed an association of younger age and lower intraocular pressure at presentation with better visual outcomes at 6-month follow-up.

• Researchers performed this retrospective, single-center, nonrandomized interventional study, including patients developing endophthalmitis after receiving an intravitreal injection of anti-VEGF agent between 2006 and 2016.
• Prior to treatment initiation, all patients received a vitreous biopsy sent for cultures: TAI group vs PPV with intravitreal antibiotics (PPV group).
• Main outcome measures included best-corrected visual acuity (BCVA) at 6-month follow-up after treatment for endophthalmitis.

• Data showed that over the course of the 10-year period, a total of 258,357 intravitreal injections occurred, of which 40 patients (0.016%) had endophthalmitis within 3 weeks after injection.
• On initial examination, 34 patients (85.0%) had pain and 25 patients (62.5%) had hypopyon.
• Researchers noted that among 24 culture-positive cases, 66.7% of the causative organisms were coagulase-negative Staphylococcus, followed by Streptococcus species (10.0%).
• For patients who had a positive culture for Streptococcus species (4.0; standard deviation [SD], 0.8) (approximately light perception) vs those who had a positive culture for coagulase-negative Staphylococcus (0.4; SD, 0.3) (~20/50) (P < 0.0001), significantly worse best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution [logMAR]) was noted at 6-month follow-up.
• It was also observed that relative to the TAI group, a higher proportion of samples were culture-positive in the PPV group (90.9% vs 48.3%, P=0.03).
• Between the TAI and PPV groups, no statistically significant difference was noted in BCVA at 6-month follow-up.
• Achieving a BCVA of 20/400 or better at 6-month follow-up after treatment was predicted by younger age (<85 years) and lower intraocular pressure (IOP) at presentation.
• At 6-month follow-up, visual outcomes were not predicted by initial management (TAI vs PPV), duration of symptoms, presence of pain, presence of hypopyon, presenting BCVA, and culture status (positive vs negative).