Intravitreal steroid injections associated with a higher incidence of endophthalmitis compared with other intravitreal injections

Investigators reported that intravitreal steroid injections were the bases for more cases of endophthalmitis compared with other intravitreal injections.

Investigators from Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, and Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, reported that intravitreal steroid injections were the bases for more cases of endophthalmitis compared with other intravitreal injections. Annika Samuelson, BS, from Wills Eye Hospital, was the lead study author.

The investigators sought to determine the clinical findings and visual outcomes in cases identified in the Wills Eye/MidAtlantic billing records from January 1, 2014, to October 20, 2020. The diagnosis, clinical information, and microbiology were confirmed for each case.

Endophthalmitis cases identified

Of the 3,925 intravitreal dexamethasone injections administered in this single practice setting, endophthalmitis developed in 4 cases and in 1 case referred from outside the practice. This translated to an incidence rate of 0.102%, i.e., 1 in every 981 injections, the investigators reported.

In this patient cohort, the mean age was 82.3 years (range, 63–88 years); the patient were treated with a mean of 11.3 intravitreal injections of dexamethasone (range, 2–30 injections) before development of endophthalmitis.

In the cases in which endophthalmitis developed, the patients presented a mean of 3.6 days after the causative injection. Gram-positive organisms were identified in 3 cases.

Intravitreal antibiotics were used successfully against the infections in all patients. The mean logarithm of the minimal angle of resolution visual acuity levels (Snellen acuity) at the time of the injection that caused the infection, at the endophthalmitis presentation, at 3 months, and at the last follow-up examination were, respectively, 0.44 (20/55), 2.22 (20/3,319), 1.18 (20/303), and 1.46 (20/577).

Based on the results, the investigators concluded that endophthalmitis occurs more often after intravitreal steroid injections compared with other intravitreal injections. Dexamethasone-attributed endophthalmitis remains uncommon, and prompt intravitreal antibiotic treatment seemed to be effective in this series.

Reference
Samuelson AG, Nahar A, Patel SN, et al. Clinical outcomes of patients with endophthalmitis after dexamethasone intravitreal implant. Retina. 2022;42(10):1915-1920. doi:10.1097/IAE.0000000000003546