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Culture-positive, culture-negative cases of presumed endophthalmitis may be difficult to distinguish
Ophthalmology. 2011;118(10):2028-2034
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While the risk of endophthalmitis after intravitreal anti-VEGF injection may be low, the difference between culture-positive and culture-negative cases may be difficult to distinguish, an analysis found.
"The presence or absence of pain, vitritis, decreased vision, or hypopyon and the interval between injection and presentation does not help to distinguish culture-positive from culture-negative cases. Thus, vitreoretinal specialists should have a low threshold to perform emergent tap and injection of intravitreal antibiotics," the study authors wrote.
Data were obtained from a single-center, consecutive case series and a retrospective, case-control study. Sixteen surgeons administered 27,736 injections, and 23 cases (0.083%) were reported as presumed infectious endophthalmitis, with seven being culture-positive.
All cases coincided with pain and vitritis a mean 3.4 days after injection. Fifteen of the 23 cases regained baseline vision within 3 months of treatment. However, a subgroup with poor visual outcomes, combined with the difficulty of distinguishing culture-positive and culture-negative cases, may warrant low threshold for treatment, according to the authors.
No modifiable risk factors were demonstrated; bladed lid speculum use, conjunctival displacement, hemisphere of injection and type of anti-VEGF agent did not affect risk. However, incidence of endophthalmitis may have been underestimated due to study design, potentially underpowering the risk factor analysis, the authors said.