Sterile Endophthalmitis after Intravitreal Injections

Abstract

Sterile endophthalmitis appears as an infrequent complication of intravitreal injections and seems to develop mainly in the context of the off-label use of drugs that have not been conceived for intravitreous administration. The aetiology of sterile endophthalmitis, independently of the administered drug, remains uncertain and a multifactorial origin cannot be discarded. Sterile inflammation secondary both to intravitreal triamcinolone acetonide and to intravitreal bevacizumab share many characteristics such as the acute and painless vision loss present in the big majority of the cases. Dense vitreous opacity is a common factor, while anterior segment inflammation appears to be mild to moderate. In eyes with sterile endophthalmitis, visual acuity improves progressively as the intraocular inflammation reduces without any specific treatment. If by any chance the ophthalmologist is not convinced by the sterile origin of the inflammation, this complication must be treated as an acute endophthalmitis because of the devastating visual prognosis of this intraocular infection in the absence of therapy.

Nanosponge-Mediated Drug Delivery Lowers Intraocular Pressure

“…66 However, repeated intraocular injection significantly increases the risk of ocular complications, including discomfort or pain, subconjunctival or vitreal hemorrhage, acute and sterile intraocular inflammation, uveitis, and endophthalmitis. 66,67 Reviews of clinical trials and patient charts to determine the safety of AMD intravitreal therapies have found that incidence rates for endophthalmitis range from 0 to 0.16%. [68][69][70][71][72][73] A longitudinal study by Rasmussen et al 29 showed that of 600 eyes that began AMD intravitreal treatment, a third of the eyes still were receiving treatment after 4 years with no change in visual activity.…”

Reliability of vitreous histological detection of pathogenic fungi in the diagnosis of fungal endophthalmitis

“…Diagnostic delay might be explained by the rarity of fungal endophthalmitis and the subacute nature of early infection, or the difficulty of distinguishing true infection from the occasionally observed postprocedural sterile inflammation. 8 The microbiological diagnosis of fungal endophthalmitis is usually based on microscopy and culture of the microorganisms in vitreous fluid. Smears made from these samples may be examined immediately after detecting the fungi by direct microscopy.…”

Corticosteroids and Anti-Complement Therapy in Retinal Diseases

“…As with periorbital injections, intravitreal injections may be repeated for recurrent disease with close monitoring for side effects. In addition to development or progression of cataract and elevation of intraocular pressure, potential adverse effects of intravitreal steroid injections include vitreous hemorrhage, retinal detachment, as well as infectious or sterile endophthalmitis (Marticorena et al 2012). …”