Bacterial endophthalmitis following anti-VEGF intravitreal injections: a retrospective case series
Abstract Background To describe the incidence of endophthalmitis and the treatment outcomes of acute bacterial endophthalmitis following intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in a Brazilian hospital. The analysis was based on the timing of infection after intrav...
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | International Journal of Retina and Vitreous |
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| Online Access: | https://doi.org/10.1186/s40942-023-00490-9 |
| _version_ | 1797451899941683200 |
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| author | Vinicius Campos Bergamo Luis Filipe Nakayama Nilva Simeren Bueno De Moraes Maria Cecília Zorat Yu Ana Luiza Höfling-Lima Maurício Maia |
| author_facet | Vinicius Campos Bergamo Luis Filipe Nakayama Nilva Simeren Bueno De Moraes Maria Cecília Zorat Yu Ana Luiza Höfling-Lima Maurício Maia |
| author_sort | Vinicius Campos Bergamo |
| collection | DOAJ |
| description | Abstract Background To describe the incidence of endophthalmitis and the treatment outcomes of acute bacterial endophthalmitis following intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in a Brazilian hospital. The analysis was based on the timing of infection after intravitreal injection, culture results, visual acuity, and the presence of epiretinal membrane after a 1-year follow-up period, spanning nine years. Methods This retrospective case series, conducted over a 9-year period, aimed to evaluate the treatment outcomes of acute endophthalmitis following intravitreal Bevacizumab injections. The inclusion criteria involved a chart review of 25 patients who presented clinical signs of acute endophthalmitis out of a total of 12,441 injections administered between January 2011 and December 2019. Negative culture results of vitreous samples or incomplete data were excluded. Ultimately, 23 patients were enrolled in the study. Eight patients were treated with intravitreal antibiotic injections (IVAI) using vancomycin 1.0 mg/0.05mL and ceftazidime 2.25 mg/0.05mL, while 15 patients underwent pars plana vitrectomy (PPV) followed by intravitreal antibiotic injections at the end of surgery (IVAIES). The main outcome measures were the efficacy of controlling the infection with IVAI as a standalone therapy compared to early PPV followed by IVAIES. Data collected included pre-infection and one-year post-treatment best corrected visual acuity (BCVA), optical coherence tomography (OCT) abnormalities, and enucleation/evisceration rates. To compare groups, Mann-Whitney and ANOVA tests were employed for statistical analysis. Results The incidence rate of bacterial endophthalmitis was 0.185% (1/541 anti-VEGF injections), with the highest infection rates observed in 2014 and 2017. Patients presented clinical symptoms between 2 and 7 days after injection. The most common isolated organisms were coagulase-negative Staphylococci and Streptococci spp. Treatment outcomes showed that both IVAI and PPV + IVAIES effectively controlled the infection and prevented globe atrophy. After one year, the PPV group with BCVA better than Light Perception had a significantly better BCVA compared to the IVAI group (p 0.003). However, PPV group had higher incidence of epiretinal membranes formation compared to the IVAI group. (P 0.035) Conclusion Anti-VEGF injections carry a risk of developing acute bacterial endophthalmitis. Isolated antibiotic therapy could be an effective treatment to control the infection, but performing PPV + IVAIES as a primary treatment showed promising results in terms of improving BCVA after one year, despite a higher rate of epiretinal membrane formation. Further studies are needed to confirm these findings. |
| first_indexed | 2024-03-09T15:01:05Z |
| format | Article |
| id | doaj.art-822570ac2d6648468ae24174335c8e52 |
| institution | Directory Open Access Journal |
| issn | 2056-9920 |
| language | English |
| last_indexed | 2024-03-09T15:01:05Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Retina and Vitreous |
| spelling | doaj.art-822570ac2d6648468ae24174335c8e522023-11-26T13:55:50ZengBMCInternational Journal of Retina and Vitreous2056-99202023-09-019111210.1186/s40942-023-00490-9Bacterial endophthalmitis following anti-VEGF intravitreal injections: a retrospective case seriesVinicius Campos Bergamo0Luis Filipe Nakayama1Nilva Simeren Bueno De Moraes2Maria Cecília Zorat Yu3Ana Luiza Höfling-Lima4Maurício Maia5Retina Division, Department of Ophthalmology, Escola Paulista de Medicina, Federal University of São PauloRetina Division, Department of Ophthalmology, Escola Paulista de Medicina, Federal University of São PauloRetina Division, Department of Ophthalmology, Escola Paulista de Medicina, Federal University of São PauloLaboratory of Ocular Microbiology, Escola Paulista de Medicina, Federal University of São PauloCornea and External Diseases Division, Escola Paulista de Medicina, Federal University of São PauloRetina Division, Department of Ophthalmology, Escola Paulista de Medicina, Federal University of São PauloAbstract Background To describe the incidence of endophthalmitis and the treatment outcomes of acute bacterial endophthalmitis following intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in a Brazilian hospital. The analysis was based on the timing of infection after intravitreal injection, culture results, visual acuity, and the presence of epiretinal membrane after a 1-year follow-up period, spanning nine years. Methods This retrospective case series, conducted over a 9-year period, aimed to evaluate the treatment outcomes of acute endophthalmitis following intravitreal Bevacizumab injections. The inclusion criteria involved a chart review of 25 patients who presented clinical signs of acute endophthalmitis out of a total of 12,441 injections administered between January 2011 and December 2019. Negative culture results of vitreous samples or incomplete data were excluded. Ultimately, 23 patients were enrolled in the study. Eight patients were treated with intravitreal antibiotic injections (IVAI) using vancomycin 1.0 mg/0.05mL and ceftazidime 2.25 mg/0.05mL, while 15 patients underwent pars plana vitrectomy (PPV) followed by intravitreal antibiotic injections at the end of surgery (IVAIES). The main outcome measures were the efficacy of controlling the infection with IVAI as a standalone therapy compared to early PPV followed by IVAIES. Data collected included pre-infection and one-year post-treatment best corrected visual acuity (BCVA), optical coherence tomography (OCT) abnormalities, and enucleation/evisceration rates. To compare groups, Mann-Whitney and ANOVA tests were employed for statistical analysis. Results The incidence rate of bacterial endophthalmitis was 0.185% (1/541 anti-VEGF injections), with the highest infection rates observed in 2014 and 2017. Patients presented clinical symptoms between 2 and 7 days after injection. The most common isolated organisms were coagulase-negative Staphylococci and Streptococci spp. Treatment outcomes showed that both IVAI and PPV + IVAIES effectively controlled the infection and prevented globe atrophy. After one year, the PPV group with BCVA better than Light Perception had a significantly better BCVA compared to the IVAI group (p 0.003). However, PPV group had higher incidence of epiretinal membranes formation compared to the IVAI group. (P 0.035) Conclusion Anti-VEGF injections carry a risk of developing acute bacterial endophthalmitis. Isolated antibiotic therapy could be an effective treatment to control the infection, but performing PPV + IVAIES as a primary treatment showed promising results in terms of improving BCVA after one year, despite a higher rate of epiretinal membrane formation. Further studies are needed to confirm these findings.https://doi.org/10.1186/s40942-023-00490-9Anti-VEGFEndophthalmitisIntravitreal injectionsRetinaVitrectomy |
| spellingShingle | Vinicius Campos Bergamo Luis Filipe Nakayama Nilva Simeren Bueno De Moraes Maria Cecília Zorat Yu Ana Luiza Höfling-Lima Maurício Maia Bacterial endophthalmitis following anti-VEGF intravitreal injections: a retrospective case series International Journal of Retina and Vitreous Anti-VEGF Endophthalmitis Intravitreal injections Retina Vitrectomy |
| title | Bacterial endophthalmitis following anti-VEGF intravitreal injections: a retrospective case series |
| title_full | Bacterial endophthalmitis following anti-VEGF intravitreal injections: a retrospective case series |
| title_fullStr | Bacterial endophthalmitis following anti-VEGF intravitreal injections: a retrospective case series |
| title_full_unstemmed | Bacterial endophthalmitis following anti-VEGF intravitreal injections: a retrospective case series |
| title_short | Bacterial endophthalmitis following anti-VEGF intravitreal injections: a retrospective case series |
| title_sort | bacterial endophthalmitis following anti vegf intravitreal injections a retrospective case series |
| topic | Anti-VEGF Endophthalmitis Intravitreal injections Retina Vitrectomy |
| url | https://doi.org/10.1186/s40942-023-00490-9 |
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