Culture Positive Infectious Endophthalmitis Associated with Intravitreal Injection Treated at the Bascom Palmer Eye Institute: A 9-year Study



To report the clinical features, medications utilized, causative organisms, and visual acuity (VA) outcomes in patients with intravitreal injection associated endophthalmitis over the past decade.


Retrospective case series.


Clinical and microbiology records were reviewed for 38 eyes of 38 patients who presented to a tertiary referral center between 2006 and 2015 with culture-positive endophthalmitis occurring within 4 weeks of intravitreal injection.


The distribution of cases included 27/38 (71%) that were referred and 11/38 (29%) that were in house. The most common pre-injection diagnosis was age related macular degeneration in 30 of 38 (79%) eyes. Medications injected included bevacizumab in 24 of 38 (63%), ranibizumab in 8 (21%), and aflibercept in 3 (8%) eyes. The mean time between injection and diagnosis of endophthalmitis was 4 days (median 3 days). Hypopyon was present in 26 of 38 (68%) and fibrin in 18 (47%) eyes. The initial treatment included intravitreal vancomycin and ceftazidime in 37 of 38 (97%) and intravitreal vancomycin and amikacin in 1 (3%) eye. Intravitreal dexamethasone was used in 26 of 38 (68%) eyes. A vitreous tap and injection with antibiotics was performed as the initial treatment in 37 of 38 (97%) and pars plana vitrectomy in 1 (3%) eyes. Coagulase-negative Staphylococcus was isolated in 18 of 38 (47%), Streptococcus species in 14 (37%), Staphylococcus warneri in 3 (8%) eyes, and Staphylococcus aureus, Bacillus, and Haemophilus Influenzae each in 1 (3%) eye. None of the gram-positive isolates were vancomycin resistant. A visual acuity of ≥20/40 was achieved in 4 of 38 (11%) eyes and ≥5/200 in 21 (55%) eyes. Ten of 38 (26%) eyes were no light perception at last follow-up, and all of these eyes had Streptococcus species.


The most common causative organisms in post-intravitreal injection endophthalmitis are gram positive. In the current study, there were no vancomycin resistant gram positive isolates. Visual outcomes were generally poor and the worst outcomes were Streptococcus cases.



Ninel Z. Gregori
Miami, FL, United States
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