Delayed-onset endophthalmitis following intravitreal injection.

PURPOSE

To report a case of endophthalmitis presenting one month after intravitreal injection.

OBSERVATIONS

An 84-year-old man presented to the retina clinic with vision loss, pain, and redness in his right eye 28 days after a routine intravitreal injection of faricimab for exudative age-related macular degeneration. The patient had a remote history of cataract surgery, rhegmatogenous retinal detachment repair, and scleral buckle explant for exposure 3 years prior. The patient was found to have endophthalmitis, characterized by a hypopyon and dense vitritis. Broad-spectrum intravitreal antimicrobials and dexamethasone were administered, and a vitreous tap returned sterile. The patient achieved initial quiescence, but he had two recurrences of inflammation in this eye over the next 4.5 months. The patient ultimately underwent pars plana vitrectomy, vitreous biopsy, intraocular lens explant, capsulectomy and repeat intravitreal antimicrobial injections for definitive treatment. Broad-range PCR testing detected . Inflammation resolved after surgery without further recurrence in the subsequent 7-month post-operative period.

CONCLUSIONS AND IMPORTANCE

species have been implicated in cases of endophthalmitis associated with glaucoma filtering surgery and trauma, but this report details a delayed-onset associated endophthalmitis after intravitreal injection.