Stem Maxwell S, Todorich Bozho, Yonekawa Yoshihiro, Capone Antonio, Williams George A, Ruby Alan J
Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan.
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.
JAMA Ophthalmol. 2017 Apr 1;135(4):379-382. doi: 10.1001/jamaophthalmol.2016.5883.
The rate of endophthalmitis following dexamethasone intravitreal implant (DEX) has varied in large clinical trials. Furthermore, to our knowledge, the optimal management of eyes with endophthalmitis associated with DEX has not been established.
To report the incidence of culture-proven endophthalmitis in a single vitreoretinal practice over the course of 3 years and describe the clinical outcomes associated with each case of endophthalmitis.
DESIGN, SETTING, AND PARTICIPANTS: All patients who received DEX between January 14, 2013, and August 31, 2016, were included in this retrospective single-center case series at a private vitreoretinal practice. The patients were identified during a search of the billing records over the period of interest. Cases of endophthalmitis associated with DEX were also identified.
Treatment with DEX.
Development of endophthalmitis following DEX and the clinical management and outcomes of each case of endophthalmitis.
Of the 1051 participants who collectively received 3593 injections of DEX, 4 patients developed endophthalmitis; all 4 patients were white, female, and 60 years or older (mean [SD] age, 75.6 [13] years). Two patients had culture-proven bacterial endophthalmitis after DEX monoinjections (0.06% of injections and 0.2% of patients). Three other cases of endophthalmitis developed after coinjection with bevacizumab (aggregate rate: 0.14% of injections and 0.38% of patients), of which 2 were culture positive. One patient developed endophthalmitis on 2 separate occasions. Vitrectomy was performed in 2 patients, and in 1 of these patients, the implant was removed. All 4 patients were treated with injection of intravitreous vancomycin and ceftazidime.
These data suggest that endophthalmitis is a rare event following injection of DEX. However, given the rarity of endophthalmitis following DEX and the heterogeneity among our reported cases, it remains unclear whether the DEX endophthalmitis rate approximates that of intravitreous anti-vascular endothelial growth factor therapy. These data also suggest that vitrectomy with removal of DEX may not be necessary in all cases of DEX-associated endophthalmitis.
在大型临床试验中，地塞米松玻璃体内植入物（DEX）后眼内炎的发生率有所不同。此外，据我们所知，与DEX相关的眼内炎患者的最佳治疗方法尚未确立。
报告在3年期间单一玻璃体视网膜诊所中经培养证实的眼内炎发生率，并描述与每例眼内炎相关的临床结果。
设计、地点和参与者：本回顾性单中心病例系列纳入了2013年1月14日至2016年8月31日期间接受DEX治疗的所有患者，该研究在一家私立玻璃体视网膜诊所进行。在检索感兴趣期间的计费记录时确定了这些患者。还确定了与DEX相关的眼内炎病例。
DEX治疗。
DEX治疗后眼内炎的发生情况以及每例眼内炎的临床管理和结局。
在总共接受3593次DEX注射的1051名参与者中，有4名患者发生了眼内炎；所有4名患者均为白人女性，年龄在60岁及以上（平均[标准差]年龄为75.6[13]岁）。2名患者在单次注射DEX后发生了经培养证实的细菌性眼内炎（占注射次数的0.06%，患者的0.2%）。另外3例眼内炎在与贝伐单抗联合注射后发生（总发生率：占注射次数的0.14%，患者的0.38%），其中2例培养结果为阳性。1名患者在两个不同时间发生了眼内炎。2名患者接受了玻璃体切除术，其中1名患者的植入物被取出。所有4名患者均接受了玻璃体内注射万古霉素和头孢他啶治疗。
这些数据表明，注射DEX后眼内炎是一种罕见事件。然而，鉴于DEX后眼内炎的罕见性以及我们报告病例之间的异质性，DEX眼内炎发生率是否接近玻璃体内抗血管内皮生长因子治疗的发生率仍不清楚。这些数据还表明，在所有与DEX相关的眼内炎病例中，不一定都需要进行玻璃体切除术并取出DEX。
