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Off-label intravitreal bevacizumab therapy for neovascular ARMD was well tolerated over 3 months with improvements in visual acuity and OCT central retinal thickness measurements. While the long-term safety and efficacy of intravitreal bevacizumab remain unknown, these short-term results suggest that intravitreal bevacizumab may be the most cost effective therapy for the treatment of neovascular ARMD.

Purpose To report a large consecutive case series of patients who developed delayed-onset and acute-onset endophthalmitis after cataract surgery. Design Retrospective consecutive case series. Methods The current study is a retrospective consecutive case series of patients treated between January 2000 and December 2009 for culture-proven endophthalmitis after cataract surgery. The study defined two groups after cataract surgery: acute-onset endophthalmitis (≤ 6 weeks after surgery) and delayed-onset endophthalmitis (> 6 weeks after surgery). Results A total of 118 patients met study criteria and included 26 delayed-onset cases and 92 acute-onset cases. The following clinical features and outcomes occurred in delayed versus acute-onset cases: (1) the presenting visual acuity was ≤ 5/200 in 31% versus 89%, (2) hypopyon was found in 46% versus 80%, (3) the most frequent isolate was Propionibacterium acnes (11/26) versus coagulase-negative Staphylococcus (57/92), (4) patients with the most frequent isolate achieved a visual outcome of ≥ 20/100 in 91% versus 56%. In delayed-onset cases, the intraocular lens was removed or exchanged in 19/26 (73%). Of these 19 cases, 13 achieved a visual outcome of ≥ 20/100. Conclusions Patients with delayed-onset endophthalmitis generally presented with better initial visual acuities, had a lower frequency of hypopyon, and had better visual outcomes compared to acute-onset patients. Propionibacterium acnes and coagulase-negative Staphylococcus species were the most common organisms cultured in delayed and acute-onset categories, respectively, and were associated with the best visual acuity outcomes in each group.

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A very low rate of endophthalmitis after intravitreal injections of anti-vascular endothelial growth factor agents was observed. Patients typically presented within 3 days of injection. Streptococcus species was the most common bacteria isolated, and it was generally associated with poor visual outcomes.

Off-label use of bevacizumab appears to be useful as a salvage treatment for ROP when laser treatment is precluded. It improves dilation, quiets the disease when visibility is difficult, and temporizes the disease until laser can be supplemented.

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