If improvement is not seen after 24 hours vitrectomy should be considered
Endophthalmitis is a serious threat to a patient's sight and can occur after any intraocular procedure. One such procedure that carries the risk of endophthalmitis is the administration of intravitreal injections. It has been reported that the risk of endophthalmitis post-injection can be as a result of the injection procedure itself or potentially as a result of drug contamination that may have occurred during preparation.
In all cases, early diagnosis and treatment of endophthalmitis is critical to avoid serious damage to the patient's visual acuity. However, the management of endophthalmitis that occurs after intravitreal injection has not been widely discussed and there are no guidelines set in place about the role of vitrectomy and silicone oil tamponade as treatment for this infection.
In a retrospective clinical study, Dr Pinarci and colleagues examined the records of just under 3000 patients who had been administered intravitreal injections between 2004 and 2011 at Baskent University Hospital. Out of this large group the team reviewed 8 patients (5 women and 3 men) who presented with acute endophthalmitis.
The initial treatment for all patients was a vitreous tap and intravitreal injections of both vancomycin and ceftazidime. In addition to this, topical antibiotics (vancomycin and ceftazidime) and an oral dose of moxifloxacin were also administered regularly. If this treatment did not improve the patient's symptoms or if they got any worse then they underwent pars plana vitrectomy with silicone oil tamponade.