Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY 10029, USA.
JAMA Ophthalmol. 2013 Jul;131(7):864-9. doi: 10.1001/jamaophthalmol.2013.88.
Our experience may be useful to other practitioners using compounded intravitreal agents, those suspecting infectious outbreaks, and those managing fungal endophthalmitis.
To describe a series of patients with fungal endophthalmitis following intravitreal injection of combined bevacizumab and triamcinolone acetonide prepared by the same compounding pharmacy.
Noncomparative case series.
Eight eyes of 8 patients who received an intravitreal injection of compounded combined bevacizumab-triamcinolone in a period of 3 weeks had subtle, nonspecific findings that were later diagnosed as fungal endophthalmitis.
Visual acuity, response to antimicrobial therapy, and number of vitreoretinal surgical operations after diagnosis of fungal endophthalmitis.
Eight patients developed endophthalmitis 41 to 97 days after receiving the intravitreal injection, which was prepared by the same compounding pharmacy. The injections occurred at the same location in New York. Treatment was based on clinical examination findings and knowledge of the etiology of the endophthalmitis. Eventually, all patients were treated with oral voriconazole. Five of 8 patients were initially treated with intravitreal antimicrobial agents. After 3 months of follow-up, visual acuities ranged from 20/50 to hand motions. Local, state, and federal health department officials were involved in investigating the source of the outbreak.
In the current study, we report a fungal endophthalmitis outbreak after intravitreal injection of contaminated, compounded combined bevacizumab-triamcinolone. In this series, Bipolaris hawaiiensis was the identified causative agent. The challenge of medical diagnosis, identification of the source of the outbreak, and management experience are highlighted in our series. Our experience may be useful to other practitioners using compounded intravitreal agents, those suspecting infectious outbreaks, and those managing fungal endophthalmitis.
我们的经验可能对其他使用复合玻璃体内药物、怀疑传染病暴发以及管理真菌性眼内炎的从业者有用。
描述一系列在同一家药房制备的联合玻璃体内注射用贝伐单抗和曲安奈德后发生真菌性眼内炎的患者系列。
非比较病例系列。
在 3 周内接受过同一家药房制备的复合联合贝伐单抗-曲安奈德玻璃体内注射的 8 名患者的 8 只眼，出现了细微的、非特异性的发现，后来被诊断为真菌性眼内炎。
诊断为真菌性眼内炎后的视力、对抗微生物治疗的反应以及玻璃体视网膜手术的次数。
8 名患者在接受玻璃体内注射后 41 至 97 天发生眼内炎，这些注射均由同一家药房制备。注射发生在纽约的同一地点。治疗基于临床检查结果和眼内炎病因学知识。最终，所有患者均接受口服伏立康唑治疗。8 名患者中有 5 名最初接受了玻璃体内抗菌药物治疗。在 3 个月的随访中，视力从 20/50 到手动不等。地方、州和联邦卫生部门官员参与了暴发源头的调查。
在目前的研究中，我们报告了在玻璃体内注射污染的复合联合贝伐单抗-曲安奈德后发生的真菌性眼内炎暴发。在本系列中，鉴定出的病原体为弯孢菌。我们的系列强调了医学诊断、暴发源头识别和管理经验方面的挑战。我们的经验可能对其他使用复合玻璃体内药物的从业者、怀疑传染病暴发的从业者以及管理真菌性眼内炎的从业者有用。
