Intravitreal injections of anti-VEGF medication is the current gold standard of care for patients with neovascular age-related macular degeneration (nAMD). A rare but serious complication of serial intravitreal anti-VEGF injections is endophthalmitis, which occurs after 0.027 to 0.15% of injections. The purpose of the study was to investigate the clinical course of patients following resolution of endophthalmitis infection.
A multicenter, retrospective analysis of 196,598 intravitreal anti-VEGF injections performed between April 2013 and October 2018 identified 75 cases of endophthalmitis (incidence 0.0381%). Seventy-two patients (96%) received an immediate intravitreal tap and injection of vancomycin (1 mg/0.1 mL) and ceftazidime (2.25 mg/0.1 mL) while three patients (4%) were taken for immediate pars plana vitrectomy with intravitreal antibiotics. Seven patients (9.3%) required repeat tap and injection of antibiotics while nine (12%) had subsequent pars plana vitrectomy. All cases were followed for at least 1.5 years.
Mean LogMAR visual acuity worsened from 0.585 ± 0.05 (20/77) prior to infection to 1.02 ± 0.11 (20/209) after infection (P < .001). Most interestingly, 17 patients (22.7%) did not require retreatment with anti-VEGF injection after resolution of endophthalmitis; 10 of these (58.8%) were due to involution/regression of the choroidal neovascular complex while seven (41.2%) were due to a poor prognosis for visual rehabilitation. Fifty-eight patients (77.3%) required reinitiation of anti-VEGF treatment but at a longer average interval of 11.6 ± 1.78 weeks compared to 7.36 ± 0.61 weeks prior to endophthalmitis (P = .003). The authors hypothesize that the overwhelming inflammation associated with endophthalmitis may lead to a reduction of choroidal neovascularization activity.
Overall, better visual acuity on post-endophthalmitis week 1 (P=0.002) and re-initiation of nAMD treatment (P=0.008) was associated with better final visual acuity while presence of streptococcus was associated with worse visual acuity (P=0.028). Patients receiving aflibercept and ranibizumab had longer treatment intervals than those being treated with bevacizumab (P<0.001).
Overall, better visual acuity on postendophthalmitis week 1 (P = .002) and reinitiation of nAMD treatment (P = .008) was associated with better final visual acuity while presence of Streptococcus was associated with worse visual acuity (P = .028). Patients receiving aflibercept and ranibizumab had longer treatment intervals than those being treated with bevacizumab (P < .001).
October 2021: VBS Literature Update
Koulisis N, Moysidis S, Govindaraju V, et al. Clinical Outcomes and Treatment Course of Eyes with Neovascular Age-Related Macular Degeneration Following the Development of Endophthalmitis. Retina 2021; 41(6):1242-1250.
Abstracted by Judy J Chen, MD
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Judy J. Chen, MD
West Coast Retina
San Francisco, CA
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Nisha Mukherjee, MD, peer reviewer, has no financial relationships with commercial interests.
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