Changes in management based on vitreous culture in endophthalmitis after intravitreal anti-vascular endothelial growth factor injection

Purpose To assess whether vitreous culture results affect the clinical management of patients with acute endophthalmitis after intravitreal anti–vascular endothelial growth factor (VEGF) injection. Design Retrospective case series. Methods Setting : Single-center. Study Population : Patients who developed endophthalmitis after intravitreal injection of aflibercept, bevacizumab, or ranibizumab between January 1, 2016, and May 31, 2018. Observation : A change in clinical management was defined as additional intravitreal antibiotic injections or pars plana vitrectomy. Main Outcome Measures : A change in clinical management within 2 weeks of initial endophthalmitis culture and treatment; visual acuity. Results Of 204,986 intravitreal anti-VEGF injections performed, 60 cases (0.0293%) of endophthalmitis were identified, 18 of which were culture-positive. Six of 60 eyes (10%) had a change in clinical management. A change in clinical management was initiated in 3 of 18 (17%) culture-positive cases compared to 3 of 42 (7%) culture-negative cases (P = .357). Changes in management for culture-positive cases were performed based on declining vision (2 cases) and worsening clinical examination (1 case). Changes in management for culture-negative endophthalmitis cases were performed based on declining vision (1 case) and worsening clinical examination (2 cases). No additional interventions were initiated based on positive-culture results. Comparing vision loss from baseline by culture result, at final follow-up, 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 (P Conclusion Following endophthalmitis from intravitreal injection of anti-VEGF agents, vitreous culture data may help prognosticate visual outcomes but appear to have a limited effect on clinical management.