gms | German Medical Science

Background: Endophthalmitis must be regarded as the severest complication after intravitreal drug administration (IVI). Recently the indication to treat with IVI is increasing, but only few data exist about complications.

Methods: This paper presents results from a retrospective study with 21 patients suffering from endophthalmitis caused by IVI between January 2008 and December 2011.

The indications to treat with IVI were as follows: Age related macular degeneration 17, central vein occlusion 1, occlusion of a branch of the retinal vein 1, diabetic retinopathy 1, uveitis 1. Four patients were treated with bevacizumab and 12 with ranibizumab. We found out incubation time, best visual acuity before injection, at the time of diagnose “endophthalmitis” and finally 3, 6 and 9 months after vitrectomy. Additionally we tested the bacterial microorganisms and described ophthalmoscopic findings.

Results: Endophthalmitis after injection was diagnosed after 6 days on average.

The visual acuity was down to hand movements. During the follow-up period the visual acuity improved only to an average of 1/35. During operation in 15 from 16 patients we observed a white infiltration of the central retina.

Hypopyon could be observed by slitlamp in 17 patients out of 21.

11 patients developed a retinal detachment in the course of clinical observation.

Conclusion: Endophthalmitis followed by IVI must be regarded as a severe complication with high risk to develop retinal detachment and causing toxic retinal damage with an outcome of poor visual acuity. The incubation time is 5 days on average.

Due to the increasing number of intravitreal injections and the danger of early retinal damage in case of bacterial infections, we recommend:

1.

strictly aseptic manipulations performing IVI.

2.

careful follow-up examinations specially during the incubation time of 6 days.