Management and Visual Outcomes of Acute Bacterial Endophthalmitis Following Intravitreal Injection of Contaminated Bevacizumab in a Single Day

Abstract

Bevacizumab requires compounding for off-label intravitreal injection, thus creating a risk of possible contamination during preparation. This retrospective, consecutive case series from a single site included patients who developed culture-proven acute endophthalmitis after intravitreal injection with contaminated bevacizumab. All patients suspected of endophthalmitis had vitreous biopsy and microbial cultures prior to initiation of treatment and were managed with immediate tap and injection of antibiotics followed early by pars plana vitrectomy. Main outcome measures included best-corrected visual acuity (BCVA) at 3-month follow-up after treatment. Twenty-four patients developed acute bacterial endophthalmitis following intravitreal injection of contaminated bevacizumab single-dose syringes in a single day. Twenty-three cases (95.8%) grew Streptococcus species and one (4.2%) grew Enterococcus species. Six cases (25.0%) had optic nerve atrophy, three (12.5%) developed retinal detachment, one (4.2%) had vitreous hemorrhage, and one (4.2%) had band keratopathy. At 3-month follow-up, compared to BCVA at the time of initial presentation, 11 patients (45.8%) had improved vision, eight (33.3%) had unchanged BCVA, and five (20.8%) had worse BCVA. However, when compared to BCVA prior to endophthalmitis (baseline), 22 cases (91.7%) had significantly worse BCVA at 3-month follow-up. Contamination of off-label bevacizumab poses devastating risk of endophthalmitis following intravitreal injection. Vigilance is needed to ensure all possible safeguards are in place to prevent contamination. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:346-352.].