Rotterdam Eye Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands. n.hoevenaars @ oogziekenhuis.nl
Ophthalmologica. 2012;228(3):143-7. doi: 10.1159/000339584. Epub 2012 Jul 12.
To report an up-to-date overview of all patients reported in the literature with suspected bacterial endophthalmitis following anti-VEGF injection. Secondly, to identify specific symptoms and signs to differentiate between infectious and noninfectious endophthalmitis.
A Pubmed search retrieved 12 retrospective case series which had included a total of 118 patients with suspected bacterial endophthalmitis after anti-VEGF injection. Data of 15 patients from the Rotterdam Eye Hospital were added. Patients were divided into three groups: those who did not receive intravitreal antibiotics (group A), patients who received intravitreal antibiotics with biopsy-negative cultures (group B) and those with biopsy-positive cultures (group C).
The median time between anti-VEGF injection and presentation with suspected bacterial endophthalmitis was 1 day in group A compared to 3 days in groups B and C. At presentation, patients of group A had a better median visual acuity (logMAR 1.0) compared to those in groups B and C (logMAR 2.1 and 2.5, respectively).
This study suggests that patients presenting with a visual acuity of 20/200 (logMAR 1.0) or less and later than 24 h after injection are more likely to have bacterial endophthalmitis. To prevent undertreatment in these patients, the threshold to proceed to vitreous biopsy and empirical intravitreous antibiotics should be low.
报告抗血管内皮生长因子（VEGF）注射后疑似细菌性眼内炎的所有文献报道患者的最新概述。其次，确定特定的症状和体征以区分感染性和非感染性眼内炎。
通过 Pubmed 检索，共纳入 12 项回顾性病例系列研究，总计 118 例抗 VEGF 注射后疑似细菌性眼内炎患者。另增加了来自鹿特丹眼科医院的 15 例患者的数据。患者分为三组：未接受玻璃体内抗生素治疗的患者（A 组）、接受玻璃体内抗生素治疗但培养阴性的患者（B 组）和培养阳性的患者（C 组）。
A 组患者在接受抗 VEGF 注射和出现疑似细菌性眼内炎之间的中位时间为 1 天，而 B 组和 C 组的中位时间分别为 3 天。在就诊时，A 组患者的中位最佳矫正视力（logMAR 1.0）优于 B 组和 C 组（分别为 logMAR 2.1 和 2.5）。
本研究表明，视力为 20/200（logMAR 1.0）或更差且注射后超过 24 小时就诊的患者更有可能患有细菌性眼内炎。为了避免对这些患者治疗不足，进行玻璃体活检和经验性玻璃体内抗生素治疗的阈值应较低。
