Endophthalmitis after intravitreal anti-vascular endothelial factor injections: Outcomes of eyes managed without microbiologic cultures: Endophthalmitis outcomes without cultures.

Abstract

PURPOSE\nTo evaluate outcomes of eyes that developed endophthalmitis after intravitreal anti-vascular endothelial growth factor injections that were managed without microbiologic cultures.\n\n\nDESIGN\nRetrospective, single-center, comparative cohort study METHODS: STUDY POPULATION: All eyes with post-injection endophthalmitis from 7/1/2013 to 9/1/2019 INTERVENTION: Endophthalmitis cases were divided into the culture group if treated with intravitreal antibiotics and a vitreous or aqueous tap sent for microbiologic sampling or into the no culture group if treated with immediate injection of intravitreal antibiotics with an anterior chamber paracentesis that was not sent for microbiologic sampling.\n\n\nMAIN OUTCOME MEASURES\nVisual acuity, incidence of retinal detachment, need for additional procedures RESULTS: Of 165 endophthalmitis cases identified, 119 (72%) were in the culture group and 46 (28%) were in the no culture group . At endophthalmitis presentation, eyes in the culture group had a mean logMAR VA of 1.98 [∼ 20/1900] compared to 1.90 [∼ 20/1600] for eyes in the no culture group (p=0.589). At six-month follow-up, mean vision loss was 5.5 lines lost from baseline for the culture group compared to 2.5 lines lost for the no culture group (p=0.017). Eyes in the culture group required a subsequent pars plana vitrectomy in 29/119 (24%) cases compared to 7/46 (15%) cases in the no culture group (p=0.29). Six of 119 (5%) eyes in the culture group developed secondary retinal detachments compared to 0 in the no culture group (p=0.143).\n\n\nCONCLUSION\nWhen access to microbiologic facility is not available, management of post-injection endophthalmitis using intravitreal antibiotics without microbiologic cultures may be an acceptable treatment strategy.