Purpose

We describe the presentation of patients developing endophthalmitis after intravitreal injection with vascular endothelial growth factor (VEGF) inhibitors. Moreover, we evaluate the management by comparing the outcomes of immediate tap and injection of intravitreal antibiotics (TAI) versus initial surgical pars plana vitrectomy (PPV). Finally, we analyze the predictive factors of visual outcomes at 6-month follow-up.

Design

Retrospective, single-center, nonrandomized interventional study.

Participants

Patients developing endophthalmitis after receiving an intravitreal injection of anti-VEGF agent between 2006 and 2016.

Methods

All patients received a vitreous biopsy sent for cultures before the initiation of treatment: TAI group versus PPV with intravitreal antibiotics (PPV group).

Main Outcome Measures

Best-corrected visual acuity (BCVA) at 6-month follow-up after treatment for endophthalmitis.

Results

A total of 258 357 intravitreal injections occurred over the course of the 10-year period, of which 40 patients (0.016%) had endophthalmitis within 3 weeks after injection. In total, 34 patients (85.0%) had pain and 25 patients (62.5%) had hypopyon on initial examination. Among 24 culture-positive cases, 66.7% of the causative organisms were coagulase-negative Staphylococcus, followed by Streptococcus species (10.0%). The best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution [logMAR]) at 6-month follow-up was significantly worse for patients who had a positive culture for Streptococcus species (4.0; standard deviation [SD], 0.8) (approximately light perception) compared with those who had a positive culture for coagulase-negative Staphylococcus (0.4; SD, 0.3) (∼20/50) (P < 0.0001). Compared with the TAI group, a higher proportion of samples were culture-positive in the PPV group (90.9% vs. 48.3%, P = 0.03). There was no statistically significant difference in BCVA at 6-month follow-up between the TAI and PPV groups. Younger age (<85 years) and lower intraocular pressure (IOP) (≤25 mmHg) at presentation were predictive of achieving a BCVA of 20/400 or better at 6-month follow-up after treatment. Initial management (TAI vs. PPV), duration of symptoms, presence of pain, presence of hypopyon, presenting BCVA, and culture status (positive vs. negative) were not found to be predictive of visual outcomes at 6-month follow-up.

Conclusions

No significant difference in BCVA at 6-month follow-up was detected between the TAI and PPV groups. Younger age and lower IOP at presentation were associated with better visual outcomes at 6-month follow-up.

中文翻译：

---

玻璃体内注射血管内皮生长因子抑制剂后眼内炎

目的

我们描述了玻璃体内注射血管内皮生长因子（VEGF）抑制剂后发展为眼内炎的患者的介绍。此外，我们通过比较立即水龙头和玻璃体内抗生素（TAI）注射与初始外科手术性平面玻璃体切除术（PPV）的效果来评估管理。最后，我们分析了6个月随访中视觉结果的预测因素。

设计

回顾性，单中心，非随机干预研究。

参加者

在2006年至2016年之间接受玻璃体内注射抗VEGF药物后发生眼内炎的患者。

方法

在开始治疗之前，所有患者均接受了玻璃体活检以进行培养：TAI组与玻璃体内抗生素的PPV组（PPV组）。

主要观察指标

眼内炎治疗后6个月的最佳矫正视力（BCVA）。

结果

在10年期间，共进行了258 357次玻璃体内注射，其中40例（0.016％）患者在注射后3周内患有眼内炎。最初检查时，共有34例患者（85.0％）感到疼痛，而25例患者（62.5％）出现了催眠。在24例培养阳性病例中，引起凝乳酶阴性的葡萄球菌占66.7％，其次是链球菌（10.0％）。对于链球菌属阳性培养的患者（4.0；标准差[SD] ），在6个月的随访中，最佳矫正视力（BCVA）（最小分辨角[logMAR]的对数）明显较差。与凝固酶阴性培养阳性的人相比，大约为0.8）（光线感知）金黄色葡萄球菌（0.4; SD，0.3）（〜20/50）（P <0.0001）。与TAI组相比，PPV组中培养阳性的样本比例更高（90.9％对48.3％，P  = 0.03）。TAI组和PPV组在6个月的随访中BCVA差异无统计学意义。较年轻的年龄（<85岁）和较低的眼内压（IOP）（≤25mmHg）预示治疗后6个月的随访中BCVA为20/400或更高。最初的治疗（TAI vs. PPV）​​，症状持续时间，疼痛的存在，hyperpyon的存在，BCVA的表现以及培养状态（阳性与阴性）在6个月的随访中均不能预测视觉效果。

结论

TAI组和PPV组之间在6个月的随访中未发现BCVA的显着差异。呈现时年龄较小和眼压降低与6个月随访时的视觉效果更好有关。