Acute Endophthalmitis Caused by Leuconostoc spp. following Intravitreal Bevacizumab Injection

We present a case of acute endophthalmitis caused by Leuconostoc spp. following intravitreal bevacizumab injection. An 86-year-old immunocompetent female developed acute endophthalmitis after intravitreal injection of bevacizumab for neovascular age-related macular degeneration. The patient presented with pain, visual acuity of hand motions, hypopyon, and dense vitritis 96 h after treatment. She was treated with vitreous and anterior chamber tap followed by intravitreal injections of 1 mg vancomycin, 2.25 mg ceftazidime, and 400 μg dexamethasone. Cultures revealed growth of Leuconostoc spp., a genus of gram-positive bacteria that is inherently resistant to vancomycin. Due to persistent inflammation, pars plana vitrectomy (PPV) with intravitreal injection of 0.4 mg amikacin was performed 16 days later, followed by resolution of endophthalmitis and return of vision to 20/40. In conclusion, the management of acute endophthalmitis caused by Leuconostoc spp., a gram-positive coccobacillus, can be particularly challenging due to its inherent resistance to vancomycin. PPV with intravitreal amikacin led to resolution of endophthalmitis. Our case expands the number of cases of endophthalmitis caused by Leuconostoc spp. and highlights the possibility of Leuconostoc-related endophthalmitis in an outpatient setting in an immunocompetent host.

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Intravitreal bevacizumab treatment for neovascular age-related macular degeneration and thromboembolic events

European Journal of Ophthalmology ◽

10.1177/1120672118823128 ◽

2019 ◽

Vol 30 (1) ◽

pp. 66-71

Author(s):

Orly Weinstein ◽

Muhammad Abu Tailakh ◽

Tova Lifshitz ◽

Victor Novack ◽

Jaime Levy

Keyword(s):

Acute Coronary Syndrome ◽

Macular Degeneration ◽

Intravitreal Bevacizumab ◽

Age Related Macular Degeneration ◽

Thromboembolic Events ◽

Coronary Syndrome ◽

Intravitreal Bevacizumab Injection ◽

Age Related ◽

Significant Difference ◽

Bevacizumab Injection

Background: Systemic complications of intravitreal anti-vascular endothelial growth factor agents are relatively uncommon but highly significant. Objectives: Primary objective: To assess the risk for thromboembolic events following intravitreal bevacizumab injection in neovascular age-related macular degeneration patients by a large population-based study. Secondary objective: To analyze the association between injection frequency and the risk for thromboembolic events, the time interval between the injection and the thromboembolic events, and the influence of chronic diseases on complications rate. Design: A retrospective cohort study. Methods: Consecutive neovascular age-related macular degeneration patients receiving intravitreal bevacizumab at Soroka University Medical Center from December 2005 to December 2013 were included. Thromboembolic events analyzed included acute coronary syndrome, acute myocardial infarction, stroke, deep vein thrombosis, and pulmonary embolism. The thromboembolic event rate was compared 2 years prior and 2 years after the initial intravitreal bevacizumab injection. Results: A total of 2102 patients were included. Acute coronary syndrome and stroke rate were higher 2 years after intravitreal bevacizumab (p = 0.03 and p = 0.01, respectively). No statistical significant difference was found for the rest of thromboembolic events. Patients older than 80 years and patients receiving less than six intravitreal bevacizumab injections were more likely to experience stroke. Patients with known cardiovascular risk factors before starting injections did not develop significant more thromboembolic events. Conclusion: In our study population, patients treated with intravitreal bevacizumab were significantly more likely to experience stroke during 2 years after first injection.

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