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Quick treatment with intravitreal antibiotics key to good outcomes for endophthalmitis

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The incidence of acute endophthalmitis after intravitreal injection of bevacizumab (IVB) is very low, with a short time between injection and presentation. Timely treatment with intravitreal antibiotics and early pars plana vitrectomy is important to maximize outcomes, according to a study.

Of 28,085 IVB injections performed during this retrospective study period, 9 eyes (9 patients) developed acute post IVB endophthalmitis, for an overall incidence of 0.032% (95% CI, 0.01-0.06) (3.2 in 10,000 injections). Three cases were culture-positive (staphylococcus epidermidis).

There was a mean time of 2.77 ± 1.25 days between IVB injection and presentation of endophthalmithis and a mean of 4 ± 1.5 previous IVB injections before developing endophthalmitis.

The mean best corrected visual acuity before IVB injection was 1.18 ± 0.62 logMAR and 2.5 ± 0.42 logMAR at the presentation of endophthalmithis. At 3 months post-treatment of endophthalmithis the mean best corrected visual acuity was 1.94 ± 0.88 logMAR.

One eye developed phthisis bulbi.

Karimi S, Fakhri N, Ansari I, et al. Incidence and management of acute endophthalmitis after intravitreal injection of bevacizumab. Int Ophthalmol. 2022; doi: 10.1007/s10792-021-02180-7. Epub ahead of print. PMID: 35079940.