Differentiating endophthalmitis after anti-VEGF injection from acute intraocular inflammation

This retrospective review analyzed nine cases of confirmed bacterial endophthalmitis after anti-VEGF injection and five culture negative cases.  Onset of symptoms began at an average of 2.55 days (range, 1-6 days) after injection in the endophthalmitis group and in one day in the acute intraocular inflammation group. Decreased visual acuity was more severe and pain on presentation was more common in endophthalmitis cases. All endophthalmitis patients had profound vitreitis and anterior chamber reaction. Treatment consisted of vitreous tap and intravitreal antibiotics injection in five cases and pars plana vitrectomy with intravitreal antibiotics injection in the remaining cases.

The authors advise that every case of uveitis after intravitreal anti-VEGF injection, however mild, should be considered as suspected endophthalmitis and investigated accordingly, and all patients should be instructed to return to their ophthalmologist at the first sign of any visual disturbance, even in the absence of pain. Furthermore, patients should be contacted at least once during the immediate postinjection period (i.e., 1 to 4 days) so that prompt action can be taken if there is suspicion of endophthalmitis. They recommend a vitreous tap combined with IVAI when there is a clear view of the retina and immediate vitrectomy for cases in which no retinal details can be seen.