In an attempt to assess whether vitreous culture results affect the clinical management of patients with acute endophthalmitis after intravitreal anti-VEGF injection, researchers from Philadelphia’s Wills Eye Hospital found that vitreous culture data may help anticipate visual outcomes but appear to have a limited effect on clinical management.

This single-center, retrospective case series evaluated patients who developed endophthalmitis after intravitreal anti-VEGF injection. Of 204,986 anti-VEGF injections performed, the team identified 60 cases of endophthalmitis (0.0293%), of which 18 were culture-positive. Three of 18 culture-positive cases (17%) had a change in clinical management, while another three of 42 culture-negative cases (7%) also underwent a management change.

The study authors changed their management strategy based on either declining vision or worsening clinical exam, and did not perform any additional interventions based on positive-culture results. Comparing vision loss from baseline by culture result at final follow-up, they note that oral flora-associated culture-positive cases lost 17.5 lines, non-oral flora-associated culture-positive cases lost 9.1 lines and culture-negative cases lost 2.5 lines of vision.

Patel SN, Storey PP, Pancholy M, et al. Changes in management based on vitreous culture in endophthalmitis after intravitreal anti-vascular endothelial growth factor injection. Am J Ophthalmol. June 13, 2019. [Epub ahead of print].