Klebsiella Cluster Endophthalmitis following Intravitreal Bevacizumab: Role of Early Detection, Pars Plana Vitrectomy, and Intracameral Moxifloxacin

Ocul Immunol Inflamm. 2022 Jan 2;30(1):11-15. doi: 10.1080/09273948.2020.1808229. Epub 2020 Sep 23.

Abstract

Aim: To report the clinical profile, outcomes of early vitrectomy for cluster endophthalmitis developing after intravitreal Bevacizumab (IVB), and discuss the role of prophylactic intracameral moxifloxacin for eyes undergoing combined cataract surgery with IVB.

Methods: Single center, retrospective analysis of 35 consecutive eyes developing post-IVB inflammation.

Results: Of the 35 eyes that were administered IVB (27 eyes 'IVB alone' and 8 eyes 'IVB with cataract surgery'). Endophthalmitis developed in 28 eyes, 6 eyes were managed with Intravitreal antibiotic (IVAB) alone, while 22 eyes required early vitrectomy. Only one eye undergoing a combined phacoemulsification with IVB developed endophthalmitis. Majority(26/28) of the eyes achieved visual acuity equal to/greater than pre-IVB injection vision over a period of 3.15 ± 3.2 months.

Conclusion: Early detection and prompt PPV were effectual for achieving good functional outcomes in our cluster of post-IVB Klebsiella endophthalmitis. Intracameral moxifloxacin was protective in cases undergoing combined cataract surgery with IVB.

Keywords: Vitrectomy in Klebsiella cluster endophthalmitis.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Bevacizumab / therapeutic use
  • Endophthalmitis* / diagnosis
  • Endophthalmitis* / drug therapy
  • Endophthalmitis* / etiology
  • Humans
  • Intravitreal Injections
  • Klebsiella
  • Moxifloxacin / therapeutic use
  • Retrospective Studies
  • Vitrectomy*

Substances

  • Anti-Bacterial Agents
  • Bevacizumab
  • Moxifloxacin