Pars Plana Vitrectomy in the Management of Patients Diagnosed With Endophthalmitis Following Intravitreal Anti-Vascular Endothelial Growth Factor Injection

In Brief Purpose: To evaluate the possible benefit of pars plana vitrectomy in the treatment of patients with endophthalmitis following antivascular endothelial growth factor (VEGF) injection. Method: The authors retrospectively reviewed the medical records of all patients in their practice with a diagnosis of endophthalmitis from January 1, 2007, through December 31, 2011. Only those with a clinical presentation consistent with endophthalmitis after intravitreal anti-VEGF injection were included. Clinical data that were collected and recorded included visual acuities and the method of initial and subsequent treatment of endophthalmitis following anti-VEGF injection: tap and injection of intravitreal antibiotics (TAP) and tap and inject with subsequent pars plana vitrectomy (VIT). Results: The authors identified 23 patients meeting criteria. Nineteen patients had received bevacizumab and four patients had received ranibizumab. The median time from last injection to presentation was 4 days (range, 1–18 days) with a median follow-up of 15 months (range, 5–48 months) after being diagnosed of endophthalmitis. Nine patients had positive cultures. The median baseline visual acuity (preendophthalmitis) was 20/70 (range, 20/25 to counting fingers at 2 ft) with a median presenting visual acuity of counting fingers at 1 ft (range, 20/50 to light perception vision). Overall, 90% (9/10) of the patients in TAP only group regained visual acuity within 1 line or better of baseline versus 46% (6 of 13) in the TAP and VIT group. Only one of the patients treated with TAP alone suffered more than one line of visual acuity loss. Conclusion: Patients diagnosed with endophthalmitis after anti-VEGF intravitreal injection who underwent TAP regained baseline visual acuity more often than those who underwent TAP and VIT. This study did not support a benefit for VIT in all patients, rather only in those cases who warranted it because of worsening clinical course. The study suggests that TAP is a viable primary intervention for endophthalmitis after anti-VEGF injection. Summary: This study focuses on the treatment of endophthalmitis following intravitreal anti-VEGF injection. This study includes 23 patients diagnosed with endophthalmitis following antivascular endothelial growth factor injection and compares the pretreatment and posttreatment visual acuities, time to obtain best-corrected visual acuities, and medical and ocular history. The treatment interventions include tap and injection of intravitreal antibiotics (TAP) and tap and inject with subsequent pars plana vitrectomy (VIT). Our study did not support a visual benefit for VIT, rather only in those cases of worsening visual acuity. Our study suggests that TAP is still a viable primary intervention for endophthalmitis after antivascular endothelial growth factor injection. Given the retrospective nature of this study, these conclusions were found with selection bias by the treating physicians.