Acute Bilateral Endophthalmitis Following Bilateral Intravitreal Bevacizumab (Avastin) Injection
A 76-year-old female was referred to our emergency clinic with complaints of bilateral ocular pain and decreased vision 1 day after receiving bilateral IVB injection for diabetic macular edema.\nOn examination, her visual acuity was hand movement and light perception in right and left eyes, respectively. There was severe cellular reaction in anterior chamber and vitreous in the right eye. Significant anterior chamber reaction with a 0.7-mm hypopyon and severe vitritis were present in the left eye. The red reflex was absent bilaterally. B-scan ultrasonography revealed inflammatory cells in the vitreous of both eyes.\nDue a high index of suspicion for bilateral postoperative endophthalmitis, the patient underwent diagnostic and therapeutic vitreous tap and intravitreal injection of 2.25 mg/0.1 ml ceftazidime and 1 mg/0.1 ml vancomycin. The vitreous sample was turbid. Two days after antibiotic injection, visual acuity improved to 20/400 in both eyes and there was a significant improvement in the symptoms and signs of inflammation. Cultures of the vitreous sample were positive for Staphylococcus epidermidis.