Do vitreous culture results affect clinical management of endophthalmitis?

Researchers examined whether vitreous culture results alter the clinical management of patients with acute endophthalmitis after anti-VEGF injection.

Study design

This was a retrospective single-center case series of patients who developed endophthalmitis after receiving anti-VEGF injections during a 2.5-year period. A total of 204,986 injections were performed during the study period.

Outcomes

Sixty eyes developed presumed infectious endophthalmitis and received vitreous tap with intraocular antibiotic injection; 18 of these were culture positive. Six eyes—3 culture positive and 3 culture negative—had a change in clinical management. Modifications to treatment were due to changes in clinical exam or visual acuity, not culture results. The authors note that no additional interventions were performed based on positive culture results.

Limitations

This study is limited by its retrospective design. Despite the large sample size, there were only 60 cases that were suspicious for infectious endophthalmitis. Approximately two-thirds of eyes with suspected endophthalmitis were culture negative, which is consistent with earlier work. The study only looked at culture results for endophthalmitis that occurred after intravitreal anti-VEGF injection and the findings are not necessarily generalizable to other causes of endophthalmitis.

Clinical significance

Although culture results should still be performed whenever possible, it may not always be feasible. Patients may live in remote areas or lack ready access to a microbiology laboratory. In these instances, it may be reasonable to perform intravitreal antibiotic injections based on the clinical examination alone as microbiology results did not alter management in this series.