Volume.122 Number.12

Original article : Clinical science

Clinical Features and Outcomes of Vitrectomy for Acute Endophthalmitis Associated with Intravitreal Injections
Tsukasa Mochizuki, Ryo Tokizawa, Masahiko Sano, Yoshinobu Emoto, Tadashi Orihara, Yoshiyuki Kita, Yuji Itoh, Kazunari Hirota, Takashi Koto, Makoto Inoue, Annabelle A Okada, Akito Hirakata
Department of Ophthalmology, Kyorin University School of Medicine

Purpose: To investigate the clinical features and outcomes of acute endophthalmitis requiring vitrectomy following intravitreal injections.
Subjects and methods: The clinical findings of cases that underwent vitrectomy at our department for acute endophthalmitis associated with intravitreal injections between April 2010 and March 2017 were retrospectively reviewed.Clinical findings of endophthalmitis following intravitreal injections were compared with post-cataract surgery endophthalmitis findings during the same period. The incidence of endophthalmitis was investigated based on the total number of intravitreal injections of anti-vascular endothelial growth factor (VEGF) drugs performed at our clinic within the same period.
Results: Vitrectomy for endophthalmitis following intravitreal injections was performed on six eyes in six patients. The indications for intravitreal injections included age-related macular degeneration in four eyes, central retinal vein occlusion in one, and uveitic macular edema in one. Bevacizumab was used in two eyes, ranibizumab in one, aflibercept in two, and triamcinolone acetonide in one. The causative bacteria were detected in three of the six eyes (50%). Methicillin-resistant Staphylococcus epidermidis was detected in two eyes and methicillin-susceptible S. aureus was detected in one. Clinical findings indicated significantly less fibrin formation in the anterior chamber in cases of endophthalmitis compared with that after cataract surgery (p<0.01). The total number of intravitreal injections of anti-VEGF drugs in our clinic over the same period was 35,860, representing an endophthalmitis incidence of 0.008%.
Conclusions: Culture positivity was observed in three of the six cases of endophthalmitis following intravitreal injections. The rate of fibrin formation in the anterior chamber was significantly lower in endophthalmitis cases than in cataract surgery cases.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 122: 912-919, 2018.

Key words
Endophthalmitis, Bacterial infection, Vitrectomy, Intravitreal injection, Anti-vascular endothelial growth factor drugs
Reprint requests to
Makoto Inoue, M.D. Department of Ophthalmlology, Kyorin University School of Medicine. 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan