Ophthalmic Consultants of Boston, Boston, Massachusetts, USA.
Ophthalmology. 2011 Oct;118(10):2028-34. doi: 10.1016/j.ophtha.2011.02.034. Epub 2011 Jun 25.
To describe outcomes of and risk factors for endophthalmitis after intravitreal anti-vascular endothelial growth factor (VEGF) injection.
Single-center, consecutive, case series and retrospective case-control study.
Between January 1, 2009, and May 31, 2010, 16 vitreoretinal surgeons administered a total of 27 736 injections. During this period, 23 cases of presumed infectious endophthalmitis occurred. Each surgeon used his own preferred injection technique.
Vitreous or aqueous tap, or both, with intravitreal antibiotic injection and subsequent topical antibiotic and steroid drops.
Visual acuity, bladed lid speculum use, conjunctival displacement, hemisphere of injection, bevacizumab versus ranibizumab, and infectious organism.
Seven of 23 cases had positive culture results; 3 grew coagulase-negative Staphylococcus. All cases had pain and vitritis on average 3.4 days (range, 1-6 days) after injection, with no difference between culture-positive and culture-negative groups. Eighteen (78%) of 23 cases had a hypopyon. Fifteen of 23 cases returned to baseline vision (±2 lines) within 3 months. Neither lid speculum use (0.10% vs. 0.066% in the no-use group; P = 0.27), conjunctival displacement (0.11% vs. 0.076% in the no-displacement group; P = 0.43), hemisphere of injection (0.11% superior vs. 0.079% inferior; P = 0.56), or bevacizumab versus ranibizumab (0.11% vs. 0.066%; P = 0.21) affected risk. Analysis of only culture-positive results yielded similar results. There was no statistically significant difference between the proportion of culture-negative cases after bevacizumab injection (83%) versus ranibizumab injection (55%; P = 0.13).
Most patients in whom presumed infectious endophthalmitis develop after anti-VEGF injection regained baseline vision after treatment. Bladed lid speculum use, conjunctival displacement, hemisphere of injection, and type of anti-VEGF agent did not affect risk. No difference in culture-negative endophthalmitis rates was detected after bevacizumab versus ranibizumab injection. Neither the presence of pain, vitritis, decreased vision, hypopyon, nor the interval between injection and development of symptoms differentiate culture-positive from culture-negative cases. Because a subgroup of patients had poor outcomes, a low threshold for vitreous tap with intravitreal antibiotic injection may be warranted.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
描述玻璃体腔内抗血管内皮生长因子（VEGF）注射后眼内炎的结局和危险因素。
单中心、连续、病例系列和回顾性病例对照研究。
2009 年 1 月 1 日至 2010 年 5 月 31 日期间，16 位玻璃体视网膜外科医生共进行了 27736 次注射。在此期间，发生了 23 例疑似感染性眼内炎。每位外科医生都使用自己偏爱的注射技术。
玻璃体或房水抽取，或两者皆有，并进行玻璃体内抗生素注射，随后局部使用抗生素和皮质类固醇滴眼剂。
视力、叶片状眼睑镜使用、结膜移位、注射半球、贝伐单抗与雷珠单抗，以及感染病原体。
23 例中有 7 例培养结果阳性，其中 3 例为凝固酶阴性葡萄球菌。所有病例在注射后平均 3.4 天（范围 1-6 天）出现疼痛和眼内炎，培养阳性组和培养阴性组之间无差异。23 例中有 18 例（78%）出现前房积脓。23 例中有 15 例在 3 个月内恢复到基线视力（±2 行）。眼睑镜使用（使用组为 0.10%，未使用组为 0.066%；P=0.27）、结膜移位（使用组为 0.11%，未使用组为 0.076%；P=0.43）、注射半球（使用组为 0.11%，未使用组为 0.079%；P=0.56）或贝伐单抗与雷珠单抗（使用组为 0.11%，未使用组为 0.066%；P=0.21）均不影响风险。仅对培养阳性结果进行分析，结果相似。贝伐单抗注射（83%）与雷珠单抗注射（55%）后培养阴性病例的比例无统计学差异（P=0.13）。
在接受抗 VEGF 注射后发生疑似感染性眼内炎的大多数患者经治疗后恢复到基线视力。叶片状眼睑镜使用、结膜移位、注射半球和抗 VEGF 药物类型均不影响风险。贝伐单抗与雷珠单抗注射后，培养阴性眼内炎的发生率无差异。注射后疼痛、眼内炎、视力下降、前房积脓和症状出现之间的间隔时间均不能区分培养阳性和培养阴性病例。由于部分患者的结局较差，因此可能需要对玻璃体进行抽吸，并玻璃体内注射抗生素。
作者没有与本文讨论的任何材料有关的专有权或商业利益。
