CLINICAL OUTCOMES AND TREATMENT COURSE OF EYES WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION FOLLOWING THE DEVELOPMENT OF ENDOPHTHALMITIS. Issue 6 (June 2021)

• Record Type: Journal Article
• Authors: Koulisis, Nicole; Moysidis, Stavros N.; Govindaraju, Viren K.; Dersch, Anne Merrylees; Capone, Antonio; Covert, Douglas J.; Dadgostar, Hajir; Dass, A. Bawa; Drenser, Kimberly A.; Engstrom, Robert E.; Faia, Lisa J.; Garretson, Bruce R.; Guerami, Amir H.; Hanscom, Thomas A.; Mahmoud, Tamer H.; Margherio, Alan R.; Oh, Kean T.; Randhawa, Sandeep; Raphaelian, Paul V.; Rhoades, William R.; Ruby, Alan J.; Sanfilippo, Christian J.; Sneed, Scott R.; Trese, Michael T.; Wolfe, Jeremy D.; Williams, George A.; Yedavally, Sunita; Hassan, Tarek S.
• Is Part Of: Retina. Volume 41:Issue 6(2021)
• Publication Date: 2021-06
• Subjects: endophthalmitis -- neovascular age-related macular degeneration -- intravitreal anti–vascular endothelial growth factor F -- VEGF -- intravitreal injections -- bevacizumab -- ranibizumab -- aflibercept -- dexamethasone -- laser -- photodynamic therapy -- optical coherence tomography -- multimodal imaging -- tap and inject -- vitrectomy -- vancomycin -- ceftazidime -- dexamethasone; Retina -- Diseases -- Periodicals; Retinal Diseases; Vitreous Body; 617.735
• DOI: 10.1097/IAE.0000000000002998
• Languages: English
• ISSNs: 0275-004X

Abstract

Abstract : Purpose: 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. Abstract : Patients with neovascular age-related macular degeneration who developed endophthalmitis after an intravitreal anti–vascular endothelial growth factor injection required less frequent treatment for neovascular age-related macular degeneration after the resolution of the infection. In 13.3% of patients, the neovascular age-related macular degeneration became quiescent, but most patients had better anatomical and functional outcomes if treatment was reinitiated.