In:
Retina, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. 6 ( 2021-06), p. 1242-1250
Abstract:
To evaluate the clinical course of patients with neovascular age-related macular degeneration (nAMD) after developing endophthalmitis during their treatment with intravitreal injections. Methods: Multicenter, retrospective series. Results: From April 2013 to October 2018, 196,598 intravitreal anti–vascular endothelial growth factor (VEGF) injections were performed, with 75 cases of endophthalmitis (incidence 0.0381%). There was no association between intravitreal anti-VEGF drug ( P = 0.29), anesthetic method ( P = 0.26), povidone concentration ( P = 0.22), or any intraprocedure variable and endophthalmitis incidence. Seventy-two patients (96%) were treated with intravitreal tap and inject , while 3 underwent immediate pars plana vitrectomy. After endophthalmitis resolution, 17 patients (22.7%) were not re-treated for nAMD (in 10 cases due to inactive disease; follow-up, 115 ± 8.4 weeks). Patients required less frequent anti-VEGF injections after infection (7.4 ± 0.61 weeks vs. 11.5 ± 1.8 weeks; P = 0.004). Preinfection logarithm of the minimum angle of resolution visual acuity was 0.585 ± 0.053 (∼20/77). It worsened with endophthalmitis (1.67 ± 0.08, ∼20/935; P 〈 0.001) and again on postendophthalmitis treatment day 1 (1.94 ± 0.064; count fingers; P 〈 0.001), but improved after reinitiating nAMD therapy (1.02 ± 0.11; ∼20/209; P 〈 0.001). Better visual acuity on postendophthalmitis week 1 ( P = 0.002) and reinitiation of nAMD treatment ( P = 0.008) were associated with better final visual acuity, and streptococcal culture with worse visual acuity ( P = 0.028). The postendophthalmitis treatment interval was associated with the anti-VEGF drug used (aflibercept = ranibizumab 〉 bevacizumab; P 〈 0.001). Conclusion: Patients with nAMD required fewer injections after endophthalmitis, suggesting a biological change in disease activity. Neovascular age-related macular degeneration became quiescent in 13.3% of eyes. Most achieved better outcomes with anti-VEGF reinitiation.
Type of Medium:
Online Resource
ISSN:
0275-004X
DOI:
10.1097/IAE.0000000000002998
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2021
detail.hit.zdb_id:
603192-4
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