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Clinical features, management, and outcomes of patients with sterile endophthalmitis associated with intravitreal bevacizumab injection: retrospective case series

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Abstract

Purpose

To evaluate clinical features, treatment protocol, outcomes, and complications that developed in this case series of 24 patients who had consecutive sterile endophthalmitis after intravitreal bevacizumab (IVB) injection.

Methods

In this retrospective case series, IVB was repackaged in individual aliquots from the three batches that were used on the same day. IVB was injected into 26 eyes of 26 patients due to diabetic macular edema, age-related macular degeneration, and branch retinal vein occlusion. All patients had intraocular inflammation. Patients were divided into two groups severe and moderate inflammation according to the intraocular inflammation. The medical records of all patients were reviewed. At each follow-up visit, the complete ophthalmologic examination was performed, including best corrected visual acuity (BCVA), intraocular pressure, biomicroscopy, and posterior fundus examination.

Results

Twenty-four of 26 patients were included in the study. Two patients were excluded from this study since they didn’t come to follow-up visits. The mean BCVA was 1.00 ± 0.52 Log MAR units before IVB. At the final visit, the BCVA was 1.04 ± 0.47 Log MAR units. These differences were not significant (p = 0.58). Of the 24 eyes, 16 eyes had severe, and 8 eyes had moderate intraocular inflammation. Eleven eyes in the severe inflammation group underwent pars plana vitrectomy due to intense vitreous opacity. Smear, culture results, and polymerase chain reaction results were negative.

Conclusion

Sterile endophthalmitis may occur after IVB injection. Differential diagnosis of sterile endophthalmitis from infective endophthalmitis is crucial to adjust the appropriate treatment and prevent long-term complications due to unnecessary treatment.

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Data availability

Case records of all cases with sterile endophthalmitis were identified by the institute’s medical record system. All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.

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Acknowledgements

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Funding

There is no funding or financial support for this study. All authors have no financial disclosures.

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Authors and Affiliations

  1. Department of Ophthalmology, University of Health Sciences, Kartal Lütfi Kirdar City Hospital, Kartal Dr. Lütfi Kirdar Egitim ve Arastirma Hastanesi Göz Klinigi, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865, Istanbul, Turkey

    Ulviye Kivrak, Aysu Karatay Arsan, Güzide Akçay, Muhammed Nurullah Bulut, Hatice Selen Kanar, Aynur Oflaz Hacısalihoğlu & Şaban Şimşek

  2. Advanced Neurological Sciences, Istanbul University Institute of Graduate Studies in Health Sciences, Istanbul, Turkey

    Ulviye Kivrak

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  1. Ulviye Kivrak
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by [U.K], [G.A], [A.H], [A.A] and [Ş.Ş]. The first draft of the manuscript was written by [U.K], [M.N.B] and [S.K] all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. All authors attest that they meet the current ICMJE criteria for authorship.

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Correspondence to Ulviye Kivrak.

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Approval was obtained from the Dr. Lütfi Kirdar Kartal City Hospital ethical review committee (Protocol Number: 2021/514/205/1).

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Kivrak, U., Arsan, A.K., Akçay, G. et al. Clinical features, management, and outcomes of patients with sterile endophthalmitis associated with intravitreal bevacizumab injection: retrospective case series. Int Ophthalmol 44, 216 (2024). https://doi.org/10.1007/s10792-024-03134-5

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