Changes in Management Based on Vitreous Culture in Endophthalmitis After Intravitreal Anti-vascular Endothelial Growth Factor Injection.

Abstract

To assess whether vitreous culture results affect the clinical management of patients with acute endophthalmitis after intravitreal anti-vascular endothelial growth factor (VEGF) injection. Retrospective case series. Setting: Single-center. Patients who developed endophthalmitis after intravitreal injection of aflibercept, bevacizumab, or ranibizumab between January 1, 2016, and May 31, 2018. A change in clinical management was defined as additional intravitreal antibiotic injections or pars plana vitrectomy. A change in clinical management within 2 weeks of initial endophthalmitis culture and treatment; visual acuity. Of 204,986 intravitreal anti-VEGF injections performed, 60 cases (0.0293%) of endophthalmitis were identified, 18 of which were culture-positive. Six of 60 eyes (10%) had a change in clinical management. A change in clinical management was initiated in 3 of 18 (17%) culture-positive cases compared to 3 of 42 (7%) culture-negative cases (P = .357). Changes in management for culture-positive cases were performed based on declining vision (2 cases) and worsening clinical examination (1 case). Changes in management for culture-negative endophthalmitis cases were performed based on declining vision (1 case) and worsening clinical examination (2 cases). No additional interventions were initiated based on positive-culture results. Comparing vision loss from baseline by culture result, at final follow-up, oral flora-associated culture-positive cases lost 17.5 lines, non-oral flora-associated culture-positive cases lost 9.1 lines, and culture-negative cases lost 2.5 lines of vision (P < .001). Following endophthalmitis from intravitreal injection of anti-VEGF agents, vitreous culture data may help prognosticate visual outcomes but appear to have a limited effect on clinical management.