Acute Bilateral Endophthalmitis Following Bilateral Intravitreal Bevacizumab (Avastin) Injection
A 52-year-old female with a history of bilateral IVB injection for diabetic macular edema, presented with bilateral ocular pain and photophobia 2 days after IVB injections. On examination, visual acuity was light perception in both eyes. There was significant anterior chamber inflammation and hypopyon in both eyes. There was 4+ cell in the vitreous. The retina was not visible due to media opacity.\nB-scan ultrasonography showed diffuse vitreous opacity bilaterally. 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. Two days later despite intravitreal antibiotics therapy, the signs and symptoms progressed and pars plana vitrectomy and intravitreal antibiotic injection was performed in both eyes. During vitrectomy, the retina appeared necrotic, especially in the macular region. Five days after vitrectomy, the signs and symptoms of endophthalmitis resolved. However, there was no improvement in visual acuity due to the retinal necrosis. Vitreous culture inoculated onto blood agar was positive for S. epidermidis.