Vitreous Tap Research Articles

The Auckland Endophthalmitis Study

Purpose:To report on the incidence and management of endophthalmitis following intravitreal bevacizumab in Auckland, New Zealand.Method:A survey of facilities in Auckland performing intravitreal bevacizumab between January 2007 and December 2014 was undertaken. The clinical notes of patients presenting with bevacizumab-related endophthalmitis were analyzed.Results:During the study period, 39 657 intravitreal bevacizumab injections were performed, with 21 patients undergoing treatment for bevacizumab-related endophthalmitis. The incidence of endophthalmitis was 0.053% (1 per 1888 injections). Most patients (76%) were treated within 4 hours from admission to hospital. Fifteen patients received vitreous tap and inject as primary treatment. From 2013 onward, there was a trend toward vitrectomy surgery as the primary intervention, with 72% of cases receiving vitrectomy as first-line treatment. Those who underwent vitrectomy were more likely to return a culture-positive result ( P = .030). After treatment, the majority of patients displayed an improvement in visual acuity (67%).Conclusion:Endophthalmitis is a rare complication of intravitreal bevacizumab treatment, with an incidence of 1 per 1888 injections in our region. There has been a shift favoring primary vitrectomy surgery in the treatment of endophthalmitis, with those undergoing vitrectomy more likely to return a positive culture result.

Outcomes of Early Pars Plana Vitrectomy for Acute Post Operative Endophthalmitis with or without Silicone Oil

Place and duration of study: Lahore General Hospital, Lahore from March 2011 to March 2016. Material and Methods: One hundred and twelve patients of acute post-surgical endophthalmitis were included in the study. Patients were randomized into two groups after no clinical improvement was seen post primary vitreous tap and intravitreal vancomycin and ceftazidime. In group 1 patients undergoing PPV with endotamponade (silicon oil) were included while in group 2 patients undergoing PPV without endotamponade were included. Study was divided in two phases. In first phase 30 patients underwent PPV without endotamponade and 30 patients with endotamponade. Considering the results of phase 1, rest of the 52 patients underwent PPV with endotamponade in phase 2. Removal of silicone oil in all patients was done at 12 weeks. Results: In first phase of study 23 (76.66%) patients in Group 2 showed retinal detachment within four weeks of follow up, while no patient (0%) in Group 1 showed retinal detachment within four weeks of follow up. Later 6 (7.31%) patients in group 1 showed retinal detachment within four weeks of silicone oil removal. In second phase all 52 patients showed no retinal detachment after undergoing PPV with endotamponade as in group 1. Overall 82 patients underwent PPV with endotamponade including first and second phase and only 6 patients got retinal detachment. Conclusion: Early PPV with endotamponade should be preferred to PPV without endotamponade in cases of acute postoperative endophthalmitis due to statistically significant improvement in anatomical and functional outcomes. Key words: Endophthalmitis, Pars plana vitrectomy, Endotamponade, Retinal Detachment, Silicone oil.

An experience of management of cluster endophthalmitis in western hilly rural region of Nepal: A descriptive, interventional study

Infectious endophthalmitis is among the most serious complications of cataract surgery. Cluster endophthalmitis is defined as five or more cases of endophthalmitis occurring on a particular day in a single operating room in one centre. The study aimed to find out causative organisms, ocular status and visual outcome after an outbreak of cluster endophthalmitis in a high volume cataract surgery in a camp. A descriptive, interventional study was carried out in 18 suspected cases of acute endophthalmitis after manual small incision cataract surgery in a single day. All clinically suspected cases underwent vitreous tap and received intravitreal injections. Vitreous samples were sent for staining and KOH mount, culture, sub-culture and sensitivity test was carried out in all vitreous specimens. Standard treatment protocol was followed. Patients were followed up till six weeks. Of the 89 eyes operated, 18 (20.2%) eyes underwent vitreous tap and intravitreal injections. Mean duration of presentation was 36 hours (24 – 48 hours). Commonest presenting symptom was redness 18 (100%), pain 83.3% (15) followed by decreased vision 77.8% (14). 10 (55.6%) eyes were culture negatives while, 8 (44.4%) were culture positive for pseudomonas aeruginosa. Six (33.3%) eyes needed core vitrectomy and repeat intravitreal injections, whereas 2 (11.1%) eyes needed repeat intravitreal injections only. Eight eyes (44.4%) got a normal visual acuity; two eyes (11.1%) fair and 8 eyes (44.4%) had poor visual acuity according to World Health Organisation (WHO) guidelines. Four eyes (22.2%) needed evisceration, while three (16.7%) eyes progressed to phthisis bulbi. Acute post operative endophthalmitis is a serious complication following cataract surgery. Prognosis of cluster endophthalmitis with proven culture positivity to pseudomonas infection is poor even with prompt standard management.

Endophthalmitis Caused by Corynebacterium Species: Clinical Features, Antibiotic Susceptibility, and Treatment Outcomes

To report the clinical features, antibiotic susceptibility profiles, treatment, and visual acuity (VA) outcomes of endophthalmitis caused by Corynebacterium species. Retrospective case series. Patients with endophthalmitis caused by Corynebacterium species. Microbiology database records were retrospectively reviewed for all patients with endophthalmitis caused by Corynebacterium species from January 1, 1990 to December 31, 2012 at a large university referral center. The corresponding clinical records were then reviewed to evaluate the endophthalmitis clinical features and treatment outcomes. presenting clinical features, visual acuity outcomes, and antibiotic susceptibility patterns. Of 10 patients identified, clinical settings included post-cataract surgery (n = 6), post-penetrating keratoplasty (n = 2), and post-trabeculectomy (n = 2). The mean time from surgical procedure to presentation with endophthalmitis was 6.8 months (range: 1 day to 28 months). All isolates were vancomycin susceptible. Presenting VA ranged from 7/200 to no light perception. Initial treatment strategies were vitreous tap and intravitreal antibiotic injection (n = 5) and pars plana vitrectomy with intravitreal antibiotic injection (n = 5). VA outcomes were ≥ 20/60 in 5 (50%) of 10 patients and ≤ 20/400 in 5 (50%) of 10 patients. The most common clinical setting was post-cataract surgery. All isolates were susceptible to vancomycin. Despite prompt treatment with appropriate antibiotics, there were variable visual outcomes.

Retrospective Study of Vitreous Tap Technique Using Needle Aspiration for Management of Shallow Anterior Chamber during Phacoemulsification

Purpose To evaluate the technique of vitreous tap using needle aspiration for management of anterior chamber shallowness during phacoemulsification. Methods A retrospective study included 26 eyes of 17 patients who underwent phacoemulsification in which vitreous tap was performed using a 27-gauge needle attached to a 5 ml syringe, inserted 3.5 mm from the limbus to aspirate 0.2 ml of liquefied vitreous if a cohesive (OVD) failed to sufficiently deepen the anterior chamber. Results Preoperative anterior chamber depth was 2.31 ± 0.26 mm, axial length was 21.7 ± 0.67 mm, lens thickness was 4.5 ± .19 mm, and cataract grade was 3.77 ± 1.4. Preoperative CDVA in LogMAR units was 0.98 ± 0.75. Coexisting angle closure glaucoma was present in 7 patients (26.92%) preoperatively. Vitreous needle tap was successful in vitreous removal on the first attempt in 26 eyes (100%). Postoperative follow-up period was 22.88 ± 10.24 (4–39) months. The final postoperative CDVA in LogMAR units was 0.07 ± 0.1, while the final postoperative IOP was 16.54 ± 1.45 mmHg. No complications related to vitreous tap were noted. Conclusion Vitreous needle tap is a simple, cost-effective, and safe technique for management of shallow anterior chamber in phacoemulsification.

Stenotrophomonas maltophilia: An emerging entity for cluster endophthalmitis.

Purpose:This was a study of acute cluster endophthalmitis along with clinical features, culture results, and visual outcomes of 10 eyes of 10 patients after intravitreal injection of Avastin (bevacizumab) in one sitting from a single vial.Methods:Retrospective review of intravitreal injection of 1.25 mg/0.05 ml bevacizumab that was given to 10 eyes of 10 patients on the same day from a freshly opened vial. All patients manifested with endophthalmitis the next day. Vitreous tap for direct smear and culture was done. Intravitreal antibiotics and steroids were injected and appropriate treatment begun. The injection vial of the same batch was sent for VITEK™ identification and antimicrobial susceptibility of isolates.Results:Endophthalmitis presented within 24 h of intravitreal injection. There was a remarkable absence of posterior pupillary synechia. Two cases were culture-positive (20%), showing pseudomonoid growth. The vial of the same batch revealed a pseudomonoid bacilli Stenotrophomonas maltophilia using VITEK™, which was resistant to multiple drugs. Hence, the contaminated vial was identified as the source of infection in our case. Among 10 patients, two underwent pars plana vitrectomy. Visual acuity returned to preendophthalmitis levels in 9/10 eyes after 1 month. One patient was lost to follow-up. Late complications included retinal detachment in one case and neovascular glaucoma in another.Conclusion:Early recognition and treatment are key factors in improving outcomes. Causative etiology could be microbial contamination of the drug vial. S. maltophilia should be considered a pathogenic organism of postintravitreal endophthalmitis.

MICROBIOLOGIC SPECTRUM AND VISUAL OUTCOMES OF ACUTE-ONSET ENDOPHTHALMITIS UNDERGOING THERAPEUTIC PARS PLANA VITRECTOMY

To report the clinical presentation, microbiologic spectrum, and visual outcomes associated with acute-onset infectious endophthalmitis undergoing therapeutic pars plana vitrectomy. Multicenter interventional retrospective noncomparative consecutive case series. Billing records were reviewed to identify all charts for patients undergoing pars plana vitrectomy within 14 days of diagnosis of acute-onset infectious endophthalmitis over a 4-year period at 5 large tertiary referral retina practices. Statistical analysis was performed to assess for factors associated with visual outcomes. Seventy patients were identified. The most common clinical setting was postcataract surgery (n = 20). Only 3 patients (4.3%) presented with 20/400 or better visual acuity (VA). Although most of the patients initially underwent vitreous tap and intravitreal antibiotic injection (n = 47, 67.1%), all patients eventually underwent pars plana vitrectomy within 14 days of presentation with 68.5% (48/70) of patients undergoing pars plana vitrectomy within 48 hours of presentation. Positive intraocular cultures were obtained in 56 patients (80%). The most common identified organism was Streptococcus sp (n = 19). Visual acuity at last follow-up was 20/400 or better in 19 patients (27.1%). Three patients underwent evisceration or enucleation (4.3%). Last recorded postoperative VA (mean LogMAR 1.99 ± 0.94, Snellen VA equivalent finger count) improved from presenting VA (mean LogMAR 2.37 ± 0.38, Snellen VA hand motions) (P ≤ 0.001). There was no statistically significant correlation between the underlying etiology or the timing of surgery with this VA outcome. Although less than one-third of patients achieved 20/400 or better VA, this VA often improved significantly from presenting VA.

Post-clear corneal phacoemulsification endophthalmitis: profile and management outcomes at a tertiary eye care center in western India.

BackgroundInfectious endophthalmitis is a serious sight threatening intraocular inflammation that results from exogenous or endogenous spread of organisms into the eye.A retrospective case series to study the profile of endophthalmitis following clear corneal phacoemulsification in western India between years 2008 and 2014 was held in the National Institute of Ophthalmology, Pune, India. Cases of endophthalmitis post-clear corneal phacoemulsification were reviewed pertaining to demography, clinical history, surgeon experience, surgical complications, time of onset following surgery, duration between onset of symptoms and presentation to the center, presenting visual acuity and at follow-ups, slit-lamp examination and ultrasound findings, vitreous tap culture results, treatment, and final functional and anatomical outcomes.ResultsOf 60 cases, 34 were operated in the tertiary center and 26 were referred. The incidence of endophthalmitis post clear corneal phacoemulsification performed at the tertiary center was 0.17%. Mean time delay between onset of symptoms and presentation to the tertiary care center was 2.6 days. Fifty percent cases were culture +ve, of which 80% were Gram +ve and 20% were Gram −ve, no fungal isolates. Coagulase –ve staphylococcus was the most common causative organism; rare isolates included Sphingomonas paucimobilis and Streptococcus mitis. Twenty-six eyes underwent primary vitrectomy. Mean presenting visual acuity was 2.14 ± 0.07 logMAR units which improved to logMAR 0.98 ± 0.12 at final follow-up. Presenting VA was >20/200 in 13.3% and <HM in 60% cases. 66.7% of eyes had visual improvement; 26.7% cases achieved VA 20/40 at final follow-up. Gram +ve and culture –ve cases, better presenting VA, and less time delay between onset and presentation had a favorable visual outcome.ConclusionsThe shift of the clinico-microbiological spectrum of endophthalmitis could be due to change in surgical technique to clear corneal phacoemulsification. Predictors of good visual outcome include good presenting visual acuity, early presentation to the center, culture negativity, and coagulase negative organisms.Electronic supplementary materialThe online version of this article (doi:10.1186/s12348-016-0115-y) contains supplementary material, which is available to authorized users.

A rare case of cytomegalovirus papillitis in patient with immunodeficiency

A 26-year-old male diagnosed with AIDS came with sudden blurred vision and central sco-toma in left eye since 2 weeks before admission. His visual acuity was counting finger at 5 meters with normal IOP and anterior segment. The posterior segment revealed edematous optic nerve covered by exudates and hemorrhages. Due to low CD4+ count and serological test result, we considered a HIV-related opportunistic ocular infection, specifically HSV infection. As visual acuity worsened during treatment with acyclovir, we performed PCR ex-amination from aqueous tap which revealed positive CMV DNA. Unfortunately, the visual acuity had worsened to no light perception before he received any specific anti-CMV agent. CMV papillitis is an unusual presentation of CMV retinitis. PCR examination from aqueous or vitreous tap should be performed while waiting for serological test result, especially in doubtful cases. Therefore, appropriate diagnosis and management can be established early to prevent irreversible visual loss.

Primary vitreo‐retinal lymphoma, an increasing pseudo‐uveitis to be taken into account

SummaryThe clinical assessment of most of vitreo‐retinal (VR) inflammations is often challenging: the clinical picture of such diseases can be overlapping and, despite the advances in medical technologies, the routine diagnostic tools might not provide conclusive data. The term ‘Masquerade Syndrome’ was first used in 1967 to describe a case of conjunctival carcinoma that mimicked a chronic conjunctivitis. Masquerade syndromes are disorders that occur with intraocular inflammation and are often misdiagnosed as a chronic resistant, non‐infectious uveitis. Very often mesquerade syndrome is a synonymous of intraocular lymphoma which can present insidious clinical pictures, which are very often confused. At this point, the possibility to take a vitreous tap via pars plana can help the ocular immunologist to differentiate between different sub‐sets of infectious diseases and masquerade syndrome. The possibility to test the interleukines’ (IL) ratio and to analyze the cytology represents a great scientific advance. Once there is the evidence of a masquarade syndrome, the urgent referral to the hematologist is mandatory, in order to start an appropriate and prompt chemotherapy, both local and systemic.

Microsporidial stromal keratitis and endophthalmitis in an immunocompetent patient.

PurposeThe purpose of this study is to report a case of microsporidial endophthalmitis after penetrating keratoplasty in a healthy patient and discuss the management.MethodsThis is a case report.ResultsA 69-year-old healthy male underwent penetrating keratoplasty for corneal scar secondary to herpes stromal keratitis. He presented with features of acute graft rejection 3 years later. After failure of medical management, a repeat full thickness keratoplasty was performed. Pathologic examination of the corneal specimen showed microsporidia. The patient then developed a chronic endophthalmitis, and a vitreous tap and injection followed by pars plana vitrectomy were performed. Pathologic examination of tissue showed microsporidia.ConclusionsMicrosporidia are being increasingly identified as the cause of stromal keratitis. This is the first report of microsporidial endophthalmitis in a patient without underlying systemic illness.

A cluster of presumed, noninfectious endophthalmitis after intravitreal injection of bevacizumab: long-term follow-up.

To report the outcome of 5 consecutive cases of presumed, noninfectious endopththalmitis following intravitreal injection of bevacizumab (IVB). Ten pre-loaded syringes of bevacizumab (1.25 mg/50 µL) furnished by a compounding pharmacy were injected intravitreally. Treatments were performed in the operating room by the same surgeon on 2 consecutive days. Of 10 eyes, 5 showed moderate to severe ocular inflammation within a few days of injection. All patients were treated in the same surgical session. Vitreous tap performed in the patient presenting with the most severe grade of inflammation was negative for bacteria and fungi. At the time of the vitreous biopsy, this patient was injected with vancomycin 1 mg/100 µL in the vitreous cavity. Other eyes with moderate inflammation received topical and systemic antibiotics and topical steroid treatment. Visual acuity returned to pre-endophthalmitis or better levels in all eyes within 1 month. The other 5 patients treated with IVB from the same batch in the other surgical session did not develop inflammation. IVB can induce noninfectious endophthalmitis. The use of compounded syringes can explain clustering of the inflammation. We were unable to identify the reasons for the variable grade of inflammation we observed in our patients.

The first case of fungal endophthalmitis caused by Emericella nidulans after cataract surgery

Emericellanidulans is a species that has only rarely been implicated in human disease after cataract surgery. Here, we report the first postoperative case in the literature, as far as we know. The patient was a 50-year-old patient presented with mild anterior uveitis one week after cataract surgery, and hypopion developed over the next two days. First microbiological evaluation and the results of direct microscopy and cultures of the anterior chamber and vitreous samples were found to be negative. Despite vigorous topical and intravitreal (vancomycin and amikacin) therapy, the endophthalmitis did not improve. Anterior chamber paracentesis, vitreous tap and finally complete vitrectomy with removal of the capsular bag including the intraocular lens (IOL) were performed. The anterior chamber, vitreous fluid samples and IOL were submitted to the microbiology laboratory: the culture yielded E.nidulans growth. Ocular inflammation resolved and vision improved on intravenous, subconjunctival and long-term oral voriconazole treatment. E.nidulans can be an important cause of ocular fungal infections including endophthalmitis, and voriconazole seems to be effective for the treatment of E.nidulans endophthalmitis.

Early treatment of acute submacular haemorrhage secondary to wet AMD using intravitreal tissue plasminogen activator, C3F8, and an anti-VEGF agent.

PurposeAcute submacular haemorrhage secondary to wet age-related macular degeneration (AMD) has a poor prognosis for which there is currently no 'gold standard' treatment. We evaluated the efficacy of early treatment using intravitreal triple therapy of tissue plasminogen activator (tPA), expansile gas, and an anti-VEGF agent.MethodsThis retrospective case series included eight patients presenting with acute submacular haemorrhage involving the fovea. All patients received treatment with 50 μg (0.05 ml) tPA, 0.3 ml 100% perfluoropropane (C3F8), and an anti-VEGF agent (0.05 mg Ranibizumab or 1.25 mg Bevacizumab in 0.05 ml) administered via intravitreal injection. An anterior chamber paracentesis post injection or vitreous tap was performed before injection to prevent retinal vascular occlusion secondary to raised intra-ocular pressure. Outcomes assessed were visual acuity, change in macular morphology, and complications.ResultsPatients presented promptly with delay between symptom onset and clinic review being 1.9±0.6 days (mean±SD). Treatment was delivered quickly with interval from presentation to treatment being 1.1±1.2 days. Symptom onset to treatment was 3.0±1.0 days. Subfoveal haemorrhage was effectively displaced in all patients. LogMAR visual acuity improved from 1.67±0.47 at presentation to 0.63±0.33 at final follow-up (P<0.0001), a mean of 7.9±4.8 months after treatment. Central retinal thickness improved from 658.1±174.2 μm at presentation to 316.6±142.4 μm at final follow-up (P=0.0028).ConclusionsEarly treatment of submacular haemorrhage using intravitreal tPA, C3F8, and anti-VEGF was effective in significantly improving visual acuity in this series of patients who presented soon after symptom onset. Treatment was well tolerated in this group of elderly and potentially frail patients.

Chronic Recurrent Pseudophakic Endophthalmitis

An immunocompetentwoman in her 80s underwent uncomplicated cataract surgery in her righteye4monthspriorwithbest-correctedvisualacuity (BCVA)of20/25OD.Twoweeks prior topresentation, shereportedagradual increase inblurredvisionwith intermittent floaters in the right eyebut deniedpain or inciting events.HerBCVAwas20/50OD. Therewere large keratic precipitates, 1+ anterior chamber cell and flare, and no hypopyon. Numerous white precipitates were noted on the anterior and posterior surface of a 3-piece posterior chamber intraocular lens (Figure, A). Therewere 2+ to 3+ anterior vitreous cells and a 2–disc area chorioretinal scar along the superior retinal arcadeswith extramacular drusen, but no areasof chorioretinitis (Figure, B). B-scanultrasonography showedaposterior vitreousdetachmentandmoderatevitreousopacities.Thecontralateralphakiceyeshowedsimilardrusen but was otherwise unremarkable. The patient underwent a vitreous tap,whichwas negative for organisms, aswell as injection of intravitreal vancomycin hydrochloride and ceftazidime in the right eye. Topical prednisolone acetate and ofloxacin were started 4 times daily, and steroids were increased toevery2hourswhile awakeat follow-up.HerBCVA improved to20/30OD4days later. TheBCVAremainedexcellent andkeraticprecipitatesdissipatedby 1monthof followup, with stable findings in the posterior pole. Topical antibiotics were stopped and topical steroidswere gradually tapered. At 2months’ follow-up, however, she had recurrent anterior chamber and vitreous inflammation with mild cystoid macular edema. Quiz at jamaophthalmology.com Fundus photograph B Slitlamp photograph A

Endophthalmitis following intravitreal injection of anti-VEGF agents: long-term outcomes and the identification of unusual micro-organisms.

BackgroundWhile the development of targeted molecular therapy to inhibit vascular endothelial growth factor (VEGF) has revolutionized the treatment and visual prognosis of highly prevalent retinal diseases such as diabetic retinopathy and age-related macular degeneration, each intravitreal injection of these agents carries a small risk of endophthalmitis which can be visually devastating. In the absence of specific guidelines, current management of post-injection endophthalmitis is typically extrapolated from data regarding endophthalmitis occurring after cataract surgery despite potential differences in pathogenic organisms and clinical course. Here, we assess the contribution of intravitreal injections of anti-VEGF agents to all cases of endophthalmitis at our tertiary care referral center and characterize the clinical outcomes and microbial pathogens associated with post-injection endophthalmitis in order to inform management of this serious iatrogenic condition.ResultsDuring the 7-year study period analyzed, 199 cases of endophthalmitis were identified using billing records. Of these, the most common etiology was post-surgical, accounting for 62 cases (31.2 %), with bleb-associated, endogenous, and corneal ulcer-related infections representing the next most frequent causes, comprising 15.6 % (31/199), 13.1 % (26/199), and 13.6 % (27/199) of all cases, respectively. Intravitreal injections of anti-VEGF agents represented 8.5 % of endophthalmitis (17/199 cases). Intraocular cultures yielded positive results in 75 % of post-injection cases, with the majority associated with coagulase-negative Staphylococcus. Consistent with prior literature, a case of Strep viridans displayed more rapid onset and progression. We also report the first association of Enterobacter cloacae and Lactococcus garvieae with post-injection endophthalmitis. While all but one patient were treated with initial vitreous tap and intravitreal injection of antibiotics, both patients with these rare organisms exhibited persistent vitritis requiring subsequent vitrectomy. Long-term outcomes of post-injection endophthalmitis indicated visual recovery to baseline levels, even with resumption of anti-VEGF agents following resolution of the acute infection.ConclusionsAcute endophthalmitis following intravitreal injections of anti-VEGF agents is an uncommon but potentially devastating complication which may be managed effectively with vitreous tap and injection of intravitreal antibiotics. However, persistent vitritis requiring subsequent vitrectomy should raise suspicion for unusual pathogens.

Incidence of Endophthalmitis after Intravitreal Anti-vascular Endothelial Growth Factor: Experience in Saudi Arabia.

Purpose:To report the incidence of endophthalmitis, the clinical and microbiological aspects, after intravitreal (IVT) injection of anti-vascular endothelial growth factor.Methods:A chart review was performed of patients diagnosed with endophthalmitis after receiving IVT injections of bevacizumab (Avastin) and ranibizumab (Lucentis) presenting to King Khaled Eye Specialist Hospital (KKESH) from May 2006 to December 2012. Endophthalmitis was diagnosed clinically as an intraocular infection with vitreous involvement that required treatment with IVT antibiotics or had undergone pars plana vitrectomy (PPV) to remove the suspected microorganism. Main outcome measures were the incidence of endophthalmitis and the clinical and microbiological features.Results:Seven cases of endophthalmitis were identified, there was 1 (0.004%) case of endophthalmitis of 22674 IVT injections performed at KKESH. All cases were after IVT bevacizumab. Three (42.85%) cases were culture-positive and caused by Staphylococcus epidermidis. The initial management was vitreous tap and IVT injection of antibiotics followed by PPV in 6 (85.7%) cases. One (14.3%) case underwent evisceration. Visual acuity improved at last visit in only 2 (28.6%) cases. The rate of endophthalmitis was 0.0004% for bevacizumab.Conclusions:The rate of endophthalmitis after IVT bevacizumab and ranibizumab was very low. We recommend following a standardized injection protocol, adherence to sterile techniques, and proper patient follow-up are determinant factors for low incidence rates. In addition, endophthalmitis after IVT bevacizumab and ranibizumab have poor visual outcomes despite prompt treatment.

Late onset endophthalmitis associated with unexposed glaucoma valved drainage device

We report an extremely rare presentation of late-onset endophthalmitis in a young adult patient with an unexposed Ahmed tube implant. The implant was inserted 11years prior to presentation. There was no history of trauma or any obvious exposure on clinical examination and the tube plate was filled with purulent material. After aqueous and vitreous tap, the patient underwent intracameral, intravitreal subconjunctival antibiotic injections and was started on systemic antibiotics with good response. Endophthalmitis associated with tube drainage device can present as late as 11years and even without an unexposed tube.

Video Recording of Vitreous Tap and Intravitreal Antibiotic Injection From the Surgeon's Perspective

Video Recording of Vitreous Tap and Intravitreal Antibiotic Injection From the Surgeon's Perspective

The influence of needle gauge and infection source on vitreous aspirate cultures

Background/aimsWhile the Endophthalmitis Vitrectomy Study (EVS) included only post-cataract surgery patients, the methods and data from that study are widely applied in the management of endophthalmitis of all types. We...