The Effect of Endophthalmitis on Recurrence of Macular Edema in Eyes Receiving Intravitreal Anti–vascular Endothelial Growth Factor

Uhr, Joshua H.; Storey, Philip; Kuley, Brandon; Patel, Samir N.; Wibbelsman, Turner D.; Pancholy, Maitri; Spirn, Marc J.

doi:10.1097/iae.0000000000003050

Cited by 4 publications

(4 citation statements)

References 32 publications

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“…The OCT results of eyes filled with silicone oil in our case series showed disruption of the inner retinal layers but stabilization of the retina in regard to changes related to wet age-related macular degeneration (AMD). This is consistent with the results obtained recently by Uhr et al [ 29 ]. They concluded that endophthalmitis after anti-VEGF injection was associated with the relative stability of the underlying exudation.…”

Section: Discussionsupporting

confidence: 94%

Urgent Vitrectomy with Vancomycin Infusion, Silicone Oil Endotamponade, and General Antibiotic Treatment in Multiple Cases of Endophthalmitis from a Single Day of Intravitreal Injections—Case Series

Pietras-Baczewska

Jasińska

Toro

et al. 2021

JCM

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The aim of this study was to report on the anatomical and functional results of surgical management of seven cases of endophthalmitis related to a single day of intravitreal aflibercept injections. Patients with signs of endophthalmitis who underwent aflibercept injections (seven eyes) performed on the same day were retrospectively evaluated. The data of visual acuity and optical coherence tomography (OCT) within nine months of the follow-up and the treatment and results of microbiological cultures are reported. Four of the total seven cases had a positive bacterial culture outcome (Streptococcus mitis). All patients underwent vitrectomy combined with phacoemulsification when the eyes were not pseudophakic, vancomycin infusion, and silicone oil tamponade within 24 h; additionally, systemic antibiotics were administered intravenously. The final best-corrected visual acuity (BCVA) after the treatment was finger counting or light perception in all cases, and all eyes were saved with disruption of the inner retinal layers and stabilization of the retina in regard to changes related to the wet age-related macular degeneration (AMD). Although the retinal anatomy was mostly preserved, most of the patients affected by Streptococcus mitis-induced endophthalmitis did not regain baseline vision after the therapy.

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Section: Discussionsupporting

confidence: 94%

Urgent Vitrectomy with Vancomycin Infusion, Silicone Oil Endotamponade, and General Antibiotic Treatment in Multiple Cases of Endophthalmitis from a Single Day of Intravitreal Injections—Case Series

Pietras-Baczewska

Jasińska

Toro

et al. 2021

JCM

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“…This in part is explained by sequelae, such as postvitrectomy cataract formation in phakic individuals and relapse of disease such as macular pathology in postinjection subjects. 13,14 Overall, visual acuity improvement is observed with respect to the median presenting visual acuity of HM and this is consistent with other studies, which show visual acuity improvement following treatment. 7,15,16 One hundred and fifty-nine patients had resultant SVL, as influenced by poor presenting visual acuity, culture positivity and absence of the red reflexthe latter being regarded as a clinical indicator of severity.…”

Section: Discussionsupporting

confidence: 89%

“…This in part is explained by sequelae, such as post‐vitrectomy cataract formation in phakic individuals and relapse of disease such as macular pathology in post‐injection subjects 13,14 . Overall, visual acuity improvement is observed with respect to the median presenting visual acuity of HM and this is consistent with other studies, which show visual acuity improvement following treatment 7,15,16 .…”

Section: Discussionsupporting

confidence: 88%

Rapid treatment of endophthalmitis with intravitreal antibiotics is associated with better vision outcomes

Michael

Welch

Niederer

2022

Clinical Exper Ophthalmology

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Background To discover whether the timing of intravitreal antibiotics, from the time of presentation to injection, affects the visual outcomes of patients with endophthalmitis from all causes. Methods A retrospective study of consecutive patients managed at Auckland District Health Board between 1 January 2004 and 1 July 2021. The main outcome measure was final visual acuity at follow‐up and the proportion of subjects with severe vision loss (≤6/60). Results Three hundred and seventy‐four eyes were included in the study, with a median age of 69.7 years at presentation; 192 subjects (51.6%) were female. The median presenting visual acuity was hand movements and hypopyon was present in 194 subjects (51.9%). Cataract surgery was the most frequent aetiology in 115 subjects (30.7%), followed by intravitreal anti‐vascular endothelial growth factor injections in 89 subjects (23.8%) and endogenous endophthalmitis in 54 subjects (14.4%). Median time to injection of intravitreal antibiotics was 3.5 h (Interquartile range 2–6). On multivariate analysis, early treatment with intravitreal antibiotics was associated with better visual outcome, particularly for those treated within 2 h, while poor presenting visual acuity and culture‐positive endophthalmitis were associated with worse outcomes. Conclusion Rapid intravitreal antibiotic administration is associated with better final visual acuity outcomes, particularly for those receiving treatment within 2 h of presentation. Patients with severe vision loss on presentation, benefit the most with improved final visual acuity following expedited treatment.

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“…After successful management of IRE in patients with AMD, studies report potential reductions in activity of the exudative disease process. In a retrospective report, 14% of eyes had no fluid recurrence post-endophthalmitis and 48% achieved a greater than 12-week recurrence free interval (as opposed to only 8.3% prior to endophthalmitis) [ 131 ]. In a case series of 7 AMD patients, Kokame et al reported that 5 of 7 had resolution of subretinal and sub-RPE fluid without the need for additional anti-VEGF injections post-infection [ 132 ].…”

Section: Resultsmentioning

confidence: 99%

Preventive factors, diagnosis, and management of injection-related endophthalmitis: a literature review

Singh

Davoudi

Ness

2022

Graefes Arch Clin Exp Ophthalmol

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Background Intravitreal medication injections represent the gold standard treatment for a variety of potentially blinding chorioretinal vascular diseases. Despite their excellent safety profile, they are associated with the feared complication of injection-related endophthalmitis (IRE). Though the overall incidence of IRE is low, due to the ever-increasing number of injections being performed, it is a complication that all retina specialists are likely to encounter. This article reviews various factors that could potentially influence the risk of IRE and discusses evidence-based strategies for management. Method PubMed was searched for keywords “intravitreal injection” and “endophthalmitis” from the period of 1995–2021. Relevant articles were reviewed and selected articles were analyzed with respect to the incidence, potential preventive factors, clinical presentation, microbial profile, management, and outcomes for IRE. Results There is strong consensus supporting the use of povidone iodine topical antiseptic, eyelid retraction away from the injection site, and avoiding treatment of eyes with active surface or eyelid disease, but there is less agreement on the use of face masks versus “no-talking” policies and optimal anesthetic technique. Current evidence comparing tap and inject or early vitrectomy for treatment of IRE is inadequate to determine an optimal treatment strategy. Conclusion Intravitreal injections are sight saving, but even using established prophylactic measures there remains a small but real risk of infectious injection-related complications. Further investigations comparing tap and inject versus vitrectomy may help to establish optimal treatment, although the rarity of IRE makes designing adequately powered prospective trials a difficult task.

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The Effect of Endophthalmitis on Recurrence of Macular Edema in Eyes Receiving Intravitreal Anti–vascular Endothelial Growth Factor

Cited by 4 publications

References 32 publications

Urgent Vitrectomy with Vancomycin Infusion, Silicone Oil Endotamponade, and General Antibiotic Treatment in Multiple Cases of Endophthalmitis from a Single Day of Intravitreal Injections—Case Series

Urgent Vitrectomy with Vancomycin Infusion, Silicone Oil Endotamponade, and General Antibiotic Treatment in Multiple Cases of Endophthalmitis from a Single Day of Intravitreal Injections—Case Series

Rapid treatment of endophthalmitis with intravitreal antibiotics is associated with better vision outcomes

Preventive factors, diagnosis, and management of injection-related endophthalmitis: a literature review

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