Endophthalmitis after anti-VEGF injections: a 25G vitrectomy approach

Session Details

Session Title: Free Paper Session 5: Anterior/Posterior Segment Surgery

Session Date/Time: Thursday 07/09/2017 | 11:00-12:30

Paper Time: 11:30

Venue: Room 117

First Author: : M.Cereda ITALY

Co Author(s): :    V. Ravera   C. Preziosa   F. Bottoni   G. Staurenghi                    

Abstract Details

Purpose:

to evaluate functional and morphological outcome of patients with acute endophthalmitis after anti-VEGF intravitreal injections for choroidal neovascularisation.

Setting:

Eye Clinic, Department of clinical and biomedical Science 'Luigi Sacco', Sacco Hospital, University of Milan, Milano

Methods:

We reviewed the charts of all the patients affected by acute endophthalmitis after anti-VEGF injections occurred in the Eye Clinic, Department of clinical and biomedical Science, Sacco Hospital, Milano, Italy from 2009 and 2016. All the patients underwent 25G vitrectomy with vitreous tap, peripheral vitrectomy extend as possible, intravitreal injection of 0,5mg Amikacin and 1,0mg Vancomicin. We evaluated visual acuity (VA) and OCT scans before the injection and from the first post surgical control thereafter.

Results:

In 42333 anti-VEGF intravitreal injections performed, an acute endophthalmitis occurred in ten patients (0.02%), one after Bevacizumab, one after Aflibercept and eight after Ranibizumab. The mean post operative onset was 3, 4 days. Vitreous tap revealed 5 cases of Staphylococcus Epidermidis, one case of Staphylococcus Warneri, one case of Staphylococcus Haemolyticus and in 3 cases was negative. One patient was lost to follow-up during the first month after injection. The remaining 9 patients had a mean follow-up of 38 months (min. 18 – max. 60). The mean VA was 0.49±0.22 before endophthalmitis, 0.28±0.22 after one month and 0.33±0.26 at the last follow-up. Seven patients recovered at least the pre-endophthalmitis VA score during follow-up (5 patients between 1 and 3 months, one patient in 16 months and one in 36 months). At the last follow-up 4 patients had the same VA score compared to pre-endophthalmitis, 4 had worse and one had better. About OCT scans, all the patients had signs of CNV activity at the first month after vitrectomy. No ischaemic and structural alteration of the retina was noted on OCT scans apart the ones due to CNV activity.

Conclusions:

25G vitrectomy and intravitreal antibiotics injections can be an effective treatment for acute endophthalmitis after anti-VEGF injections. VA recovery can be fast and stable. In our patients VA seems to be more affected by underline pathology than from the endophthalmitis itself.

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