Endophthalmitis Following Intravitreal Anti-Vascular Endothelial Growth Factor Injections for Neovascular Age-Related Macular Degeneration

Abstract

Endophthalmitis following intravitreal injections of therapeutic medications is a rare but potentially vision-threatening problem. Infectious agents associated with endophthalmitis following injection of vascular endothelial growth factor (VEGF) inhibitors are typically Gram positive organisms with a predominance of Streptococcal and Staphylococcal microbiologic isolates. Patients with infectious endophthalmitis generally present within the first 72 hours following an intravitreal anti-VEGF injection with complaints of pain, redness, and decreased vision. Prompt treatment with a conventional endophthalmitis management approach may mitigate irreversible vision loss; however, poorer outcomes have been reported with more virulent organisms such as those associated with Streptococcal species. As the number of intravitreal injections performed each year continues to increase, ophthalmologists must maintain a rigorous approach to their injection technique and remain vigilant for the signs and symptoms of endophthalmitis.

Keywords::

• anti-VEGF
• bevacizumab
• ranibizumab
• pegaptanib
• endophthalmitis
• intravitreal injection

ACKNOWLEDGMENT

Declaration of interest: Dr. Moshfeghi serves as a compensated consultant and a speaker on behalf of the following entities: Genentech, Inc., Carl Zeiss Meditec, Inc., and Allergan, Inc.; serves as a compensated consultant to Alimera, Inc., Alcon Inc., Bausch & Lomb, Inc., QLT Inc., and Eyetech, Inc; received research funding directed to his employer, the University of Miami, from Thrombogenics Inc., and holds an equity position in RetinaSense, LLC, Convene, LLC, and Realm Global, LLC.