Ocul Immunol Inflamm. 2025 Oct 22:1-9. doi: 10.1080/09273948.2025.2572755. Online ahead of print.
ABSTRACT
PURPOSE: To describe clinical features, treatment outcomes, and microbiological isolates in eyes with presumed post-injection endophthalmitis (PIE) following anti-vascular endothelial growth factor (anti-VEGF) injection for retinopathy of prematurity (ROP).
METHODS: Medical records data of preterm infants diagnosed with PIE, from multiple centres, between October 2017 and March 2025 were reviewed. Details of the type of anti-VEGF, setting of the procedure, duration between injection and diagnosis, and clinical features were recorded. The details of treatment, microbiological evaluation, additional treatment for endophthalmitis or ROP, and final structural outcomes were documented.
RESULTS: Twenty-three eyes of 23 infants treated with Ranibizumab (n = 13), Bevacizumab (n = 9), and Aflibercept (n = 1) were diagnosed with presumed PIE at a median of four days (IQR-4) after injection. Clinical features included conjunctival congestion (12, 52.8%), corneal edema (10, 43.8%), fibrinous membrane, or hypopyon in anterior chamber (10, 43.5%), posterior synechiae (6, 26.1%), and vitritis with exudation (19, 82.6%). Eighteen eyes (78.3%) were initially treated with intravitreal antibiotic, of which 11 eyes needed vitrectomy for persistent vitritis. The globe was salvaged in 14 eyes (60.9%), with attached retina in 12 eyes (52.2%). Nine eyes (39.1%) had phthisis bulbae. Five eyes had culture proven PIE (5/17, 29.4%) and isolates included Pseudomonas aeruginosa (n = 2), Streptococcus salivaris (n = 1), Streptococcus mitis (n = 1) and Candida tropicalis (n = 1).
CONCLUSION: Examination within a week after the injection can identify most eyes with presumed PIE, with vitreous exudation being the most consistent clinical feature. Isolated microorganisms are virulent. Following treatment, the possibility of poor structural outcome is higher than in adults with PIE.
PMID:41122923 | DOI:10.1080/09273948.2025.2572755
