Outbreak of Acute and Subacute Post-Injection Endophthalmitis caused by Pseudomonas aeruginosa
Investigative Ophthalmology & Visual Science
Purpose : To report the atypical presentation, clinical course, and visual outcomes associated with post-injection endophthalmitis (PIE) caused by Pseudomonas aeruginosa.
Methods : A detailed retrospective review was conducted of four cases of Pseudomonas aeruginosa PIE who presented from May – September, 2021 to different ophthalmology practices in Michigan.
Results : Four patients undergoing treatment for age-related macular degeneration (n=3) or diabetic macular edema (n=1) received right eye intravitreal injections of aflibercept (n=1), ranibizumab (n=1), bevacizumab (n=1), or dexamethasone implant (n=1) at two separate ophthalmic practices by three different providers on four separate dates. All patients were pseudophakic with a baseline vision of 20/20 to 20/50. Each patient subsequently developed rapid vision loss to hand motion (n=3) or light perception (n=1) and diagnosed with Pseudomonas aeruginosa endophthalmitis by aqueous fluid culture. Onset of endophthalmitis post-injection varied significantly with two patients presenting at the typical acute time frame (3 and 10 days post-injection) and the other two patients presenting during the subacute period (27 and 36 days post-injection). All patients received intravitreal vancomycin and ceftazidime and aqueous fluid biopsy on day of presentation, followed by a vitrectomy, vitreal biopsy, and repeat intravitreal antibiotics within 1-3 days after presentation. Despite all Pseudomonas strains being pansusceptible, these eyes continued to remain Pseudomonas culture positive on subsequent biopsies despite repeated intravitreal ceftazidime injections. There was a high incidence of post-vitrectomy choroidals and retinal detachment (n=3) which was associated with worse visual outcomes.
Conclusions : As far as the authors are aware, this is the first series of PIE caused by Pseudomonas aeruginosa. Important insights can be made into the atypical presentation and disease course to help guide future management. Unlike other cases of bacterial PIE, Pseudomonas persists within the eye despite intravitreal antibiotic injections with adequate coverage. In addition, a high rate of post-operative choroidals and retinal detachment were observed. Therefore, early vitrectomy, repeat antibiotic injections, and placement of silicone oil should be considered in these patients.
Runner MM, Begaj T, Scoles D, Trese M, Park J, Drenser KA, et al [Williams GA, Randhawa S, Ruby AJ] Outbreak of acute and subacute post-injection endophthalmitis caused by Pseudomonas aeruginosa. Invest Ophthalmol Vis Sci. 2022 June;63(7):710 – F0235.