Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Ophthalmology. 2014 Mar;121(3):702-8. doi: 10.1016/j.ophtha.2013.10.015. Epub 2014 Jan 16.
To report the histopathologic findings of a series of patients from an outbreak of Streptococcal endophthalmitis after intravitreal injection of bevacizumab prepared by a single compounding pharmacy.
Case series.
Seven surgical specimens (5 enucleated globes and 2 evisceration specimens) from 7 patients with endophthalmitis after intravitreal injection of bevacizumab.
Retrospective case series, including clinical data and histopathologic specimens examined by light microscopy.
Review of clinical data included baseline visual acuity, clinical intervention, and time elapsed from injection to loss of globe. Histopathologic specimens were reviewed for pathologic changes at all tissue levels.
Seven of 12 total patients (4 women, 3 men; mean age, 77.7 years) from an outbreak of Streptococcus mitis/oralis endophthalmitis after bevacizumab injection ultimately sustained loss of the affected globe, with an average of 139.1 days elapsed between injection and globe loss. Mean time from injection to presentation was 2.86 days (range, 1-6), and all patients were initially treated with vitreous tap and injection. Although histologic review of surgical specimens disclosed a wide range of pathologic tissue changes, recurring patterns of tissue damage were evident. All 5 enucleated globes displayed retinal detachment, fibrous proliferation with cyclitic membrane formation, rubeosis iridis, and secondary angle closure. All 7 specimens displayed persistent choroidal inflammation, in 1 case 208 days after injection. Six of 7 specimens had foci of retinal necrosis. Although vitreous cultures were positive in all cases, no organisms were identified by light microscopy in any of the 7 specimens.
S. mitis/oralis endophthalmitis is a devastating complication of intravitreal injection with bevacizumab with a high rate of globe loss (7 of 12 patients, 58.3%) and a wide variety of severe pathologic tissue changes. Although no organisms were identified in the examined tissues, persistent inflammation was present in all cases, and fibrous proliferation resulted in cyclitic membrane formation and retinal detachment in all enucleated globes. These findings suggest that potential globe-salvaging interventions must address a pattern of changes involving persistent, chronic inflammation and fibrovascular proliferation as key components.
报告在单一药剂配制药房制备的贝伐单抗玻璃体内注射后发生的链球菌眼内炎爆发的一系列患者的组织病理学发现。
病例系列。
7 名眼内炎患者的 7 个手术标本（5 个眼球摘除标本和 2 个眼球内容剜除标本）。
回顾性病例系列，包括通过光镜检查的临床数据和组织病理学标本。
回顾性临床数据包括基线视力、临床干预以及从注射到眼球丧失的时间。对所有组织层面的组织病理学标本进行了病理性改变的检查。
在贝伐单抗注射后发生的米氏链球菌/口腔链球菌眼内炎爆发中，12 例患者中有 7 例（4 名女性，3 名男性；平均年龄 77.7 岁）最终失去了受累眼球，从注射到眼球丧失的平均时间为 139.1 天。从注射到就诊的平均时间为 2.86 天（范围 1-6），所有患者最初均接受玻璃体抽吸和注射治疗。尽管手术标本的组织学检查显示出广泛的组织病变，但组织损伤的反复模式是明显的。5 个眼球摘除标本均显示视网膜脱离、纤维性增生伴睫状膜形成、新生血管性青光眼和继发性房角关闭。7 个标本均显示持续性脉络膜炎症，其中 1 例在注射后 208 天。7 个标本中有 6 个有视网膜坏死灶。尽管所有病例的玻璃体培养均为阳性，但在 7 个标本中均未通过光镜识别出任何病原体。
米氏链球菌/口腔链球菌眼内炎是贝伐单抗玻璃体内注射的一种严重并发症，眼球丧失率高（12 例患者中有 7 例，58.3%），并伴有广泛的严重组织病变。尽管检查组织中未发现任何病原体，但所有病例均存在持续性炎症，所有眼球摘除标本中均存在纤维性增生，导致睫状膜形成和视网膜脱离。这些发现表明，潜在的眼球保存干预措施必须针对涉及持续性、慢性炎症和纤维血管增生的变化模式作为关键组成部分。
