Hemorrhagic Vasculitis and Retinopathy Heralding as an Early Sign of Bacterial Endophthalmitis After Intravitreal Injection

Abstract

Purpose: To describe a case series of postintravitreal injection, bacterial endophthalmitis heralded by hemorrhagic retinal vasculitis. Methods: Observational case series of three patients with a history of intravitreal injections for age-related macular degeneration at a tertiary referral center who presented with vision changes and eye pain that were eventually found to have bacterial endophthalmitis. Clinical course was then followed. Results: All patients developed bacterial endophthalmitis and hemorrhagic retinal vasculitis. Conclusion: These three cases highlight the importance of hemorrhagic retinal vasculitis as the presenting fundus finding of bacterial endophthalmitis and that this finding in a postinjection patient should be treated as endophthalmitis until proven otherwise.

Retinal Vasculitis After Intravitreal Pegcetacoplan: Report From the ASRS Research and Safety in Therapeutics (ReST) Committee

“…However, endophthalmitis-related retinal vasculitis cases also typically had whitish exudates along the retinal vessels, and often these eyes quickly progressed to more fulminant endophthalmitis with hypopyon and dense vitritis. [29][30][31][32][33] Some of the retinal findings in the more severe cases in our series of pegcetacoplan-associated retinal vasculitis could be consistent with vasculitis related to early bacterial endophthalmitis; however, we believe that bacterial infection is unlikely in these eyes for the following reasons:…”

Literature review and proposal of best practice for ophthalmologists: monitoring of patients following intravitreal brolucizumab therapy

“…Various inflammatory conditions encompass IOI including bacterial endophthalmitis, which is associated with all intraocular injections, and isolated cases of retinal vasculitis or vascular occlusion have previously been reported with anti-VEGF therapy [ 16 , 17 , 25 ]. The mechanism behind IOI is not fully understood.…”

“…The primary site of inflammation in intermediate uveitis is the vitreous body and/or pars plana, although peripheral venous vascular sheathing and macular oedema may also be involved in some cases [ 25 ]. A semi-quantitative grading of the degree of inflammation (anterior chamber cells, flare) with fluorescein angiography is recommended to monitor the progression of any inflammation which arises.…”

Occlusive Retinal Vasculitis Following Intravitreal Drug Delivery

“…40,41 A similar presentation has been described in cases of bacterial endophthalmitis following IVT injection. 27,42,43 Chen et al 34 retrospectively studied 40 eyes of 40 patients who developed exogenous bacterial endophthalmitis with retinal vasculitis and posterior pole pre-retinal exudates seen over a 10-year period at a tertiary referral center in Taiwan. Preceding events included cataract surgery (n = 30; 75.0%), trauma (n = 5; 12.5%), trabeculectomy (n = 2; 5.0%), and one each (2.5%) for penetrating keratoplasty, pars plana vitrectomy (PPV) and iridoplasty.…”