Purpose: To present a series of cases of acute endophthalmitis after intravitreal (IVT) sustained-release dexamethasone implantation (Ozurdex) with an unusually delayed onset. Methods: A retrospective review was performed of 3 patients presenting to West Virginia University Eye Institute and diagnosed with acute endophthalmitis 16 days, 18 days, and 35 days after dexamethasone implantation. The presenting visual acuities (VAs) were counting fingers at face to hand motions (HM) only. Each patient had an aqueous or vitreous tap with injection of IVT antibiotics followed by pars plana vitrectomy. The dexamethasone implants were not removed. Results: All cultures returned positive, including Staphylococcus aureus, Staphylococcus epidermidis, and Granulicatella adiacens. The 3 patients’ final VAs were 20/60, 20/100, and HM only, respectively. Conclusions: Delayed-onset acute endophthalmitis after dexamethasone implantation represents a clinical challenge, potentially occurring up to weeks after the injection. Sustained suspicion for endophthalmitis is warranted given that cases may present beyond what is typical for postinjection endophthalmitis.
EterNMohrAWachtlinJ, et al. Dexamethasone intravitreal implant in retinal vein occlusion: real-life data from a prospective, multicenter clinical trial [published correction appears in Graefes Arch Clin Exp Ophthalmol. 2017 Jan;255(1):89. doi: 10.1007/s00417-016-3568-7]. Graefes Arch Clin Exp Ophthalmol. 2017;255(1):77-87. doi:10.1007/s00417-016-3431-x
2.
LowderCBelfortRJrLightmanS, et al. Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. Arch Ophthalmol. 2011;129(5):545-553. doi:10.1001/archophthalmol.2010.339
3.
BoyerDSYoonYHBelfortRJr, et al. Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology. 2014;121(10):1904-1914. doi:10.1016/j.ophtha.2014.04.024
4.
VanderBeekBLBonaffiniSGMaL.The association between intravitreal steroids and post-injection endophthalmitis rates. Ophthalmology. 2015;122(11):2311-2315.e1. doi:10.1016/j.ophtha.2015.07.005
5.
PancholyMStoreyPPWoodEH, et al. Incidence and visual outcomes of endophthalmitis after intravitreal injection of dexamethasone implant vs ranibizumab. J Vitreoretin Dis. 2022;6(5):358-366. doi:10.1177/24741264221109376
6.
StemMSTodorichBYonekawaYCaponeAJrWilliamsGARubyAJ.Incidence and visual outcomes of culture-proven endophthalmitis following dexamethasone intravitreal implant. JAMA Ophthalmol. 2017;135(4):379-382. doi:10.1001/jamaophthalmol.2016.5883
7.
MarchinoTVelaJIBassaganyasFSánchezSBuilJA.Acute-onset endophthalmitis caused by alloiococcus otitidis following a dexamethasone intravitreal implant. Case Rep Ophthalmol. 2013;4(1):37-41. doi:10.1159/000348809
8.
Arıkan YorgunMMutluMTokluYCakmakHBCağılN.Suspected bacterial endophthalmitis following sustained-release dexamethasone intravitreal implant: a case report. Korean J Ophthalmol. 2014;28(3):275-277. doi:10.3341/kjo.2014.28.3.275
9.
SalceanuSOHamadaDUrsuRGSaadAA.Staphylococcus lugdunensis endophthalmitis following dexamethasone intravitreal implant. Indian J Ophthalmol. 2019;67(3):424-426. doi:10.4103/ijo.IJO_720_18
10.
Al ZamilWYassinSA. Acute bacterial endophthalmitis following dexamethasone intravitreal implant: a case report. Saudi J Med Med Sci. 2019;7(2):110-113. doi:10.4103/sjmms.sjmms_57_17
11.
Cruz-IñigoYJKleinKReddyRK.Case report of abiotrophia defectiva endophthalmitis after repeated injections of dexamethasone intravitreal implant (Ozurdex). Retin Cases Brief Rep. 2022;16(2):170-173. doi:10.1097/ICB.0000000000000925
12.
GoelN.Acute bacterial endophthalmitis following intravitreal dexamethasone implant: a case report and review of literature. Saudi J Ophthalmol. 2017;31(1):51-54. doi:10.1016/j.sjopt.2016.12.003
13.
ChinYYBYeoTHBakthavatsaluM, et al. Acute atypical endophthalmitis following intravitreal sustained-release dexamethasone implant: a case series. Retin Cases Brief Rep. 2024;18(2):155-158. doi:10.1097/ICB.0000000000001369
14.
Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis Vitrectomy Study Group. Arch Ophthalmol. 1995;113(12):1479-1496.
15.
SamuelsonAGNaharAPatelSN, et al. Clinical outcomes of patients with endophthalmitis after dexamethasone intravitreal implant. Retina. 2022;42(10):1915-1920. doi:10.1097/IAE.0000000000003546
16.
MahalingamPTopiwallaTTGanesanG.Drug-resistant coagulase-negative staphylococcal endophthalmitis following dexamethasone intravitreal implant. Indian J Ophthalmol. 2017;65(7):634-636. doi:10.4103/ijo.IJO_810_16
17.
BarnesACRathbunSLKuthyarS, et al. Clinical management of an outbreak of nutritionally variant streptococcus endophthalmitis following intravitreal bevacizumab injection. Int J Retina Vitreous. 2021;7(1):18. doi:10.1186/s40942-021-00287-8
18.
SteinmetzRLSteinmetzCZReyes-CapoDP, et al. Nutritionally variant streptococci causing endophthalmitis associated with intravitreal anti-vascular endothelial growth factor injection. Am J Ophthalmol Case Rep. 2021;21:101019. doi:10.1016/j.ajoc.2021.101019
NelsonMLTennantMTSSivalingamARegilloCDBelmontJBMartidisA.Infectious and presumed noninfectious endophthalmitis after intravitreal triamcinolone acetonide injection. Retina. 2003;23(5):686.
22.
BastakisGGStavrakakisANikolaosADimopoulosDPappasG.Acute onset of exogenous endophthalmitis after dexamethasone implant injection treated without implant removal. Case Rep Ophthalmol Med. 2018;2018:4614802. doi:10.1155/2018/4614802
