A Rare Case of Bilateral Post Intravitreal Avastin Endophthalmitis with Bilateral Good Visual Outcome – A Case Report

Abstract

This is a case report of post intravitreal injection endophthalmitis encountered at the University Teaching Hospitals–Eye Hospital in Lusaka, Zambia. Endophthalmitis is a clinical diagnosis made when intraocular inflammation involving both the anterior and posterior chambers is attributable to bacterial or fungal infection. Post injection endophthalmitis is a dreaded complication that occurs following intraocular surgery or procedures such as intravitreal administration of anti-vascular endothelial growth factors or corticosteroids. We attended to a rare case of bilateral post intravitreal injection endophthalmitis in a 51- year- old female patient who presented with bilateral severe pain and acute visual loss in both eyes following intravitreal injection of Avastin (bevacizumab) the previous day. On examination, there was severely decreased visual acuity from 6/36 right eye and 6/60 left eye to hand movement in both eyes. There was also corneal haziness, fibrin in the anterior chambers, hypopyon and vitreous cells in both eyes. A clinical diagnosis of bilateral post-injection endophthalmitis was made. There was immediate administration of intravitreal antibiotics of Vancomycin 1.0mg/0.1mL and Ceftazidime 2.25mg/0.1mL with intravitreal Dexamethasone 0.4mg/0.1ml stat dose and systemic ciprofloxacin 750mg 12 hourly for 7 days. Due to prompt diagnosis and treatment vision recovery was excellent in both eyes and both eyes were preserved.