CLINICAL CHARACTERISTICS OF ENDOPHTHALMITIS AFTER AN INJECTION OF INTRAVITREAL ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR DAPHNA MEZAD-KOURSH, MD,*† MICHAELLA GOLDSTEIN, MD,*† GAD HEILWAIL, MD,*† SHIRI ZAYIT-SOUDRY, MD,*† ANAT LOEWENSTEIN, MD,*† ADIEL BARAK, MD*† Purpose: The purpose of this study was to describe the clinical characteristics and management of patients with bacterial endophthalmitis after an intravitreal antivascular endothelial growth factor injection. Methods: This is a retrospective chart review of all patients admitted with suspected endophthalmitis from 2006 to 2008. Results: Endophthalmitis was verified by positive Gram stain and culture in nine eyes. The mean preinjection visual acuity of the 9 eyes was 0.02 6 0.021 diopters (decimal visual acuity scale) and dropped to 0.01667 6 0.02449 diopters in the eyes with endophthalmitis. All nine patients presented with reduced visual acuity, of whom seven also had ocular pain. Initial treatment was administered without delay and consisted of vitreous tap and intravitreal antibiotics injection in five cases and pars plana vitrectomy with intravitreal antibiotics injection in the other four cases. Vitreous tap failed in one case. Seven patients underwent a second procedure and two underwent a third procedure. The mean posttreatment visual acuity in all 9 eyes improved significantly (0.19 6 0.24, P = 0.0071). Five patients had major complications (e.g., retinal detachment, phacolytic glaucoma, and recurrent endophthalmitis). Conclusion: Acute endophthalmitis following anti-VEGF injection appears within days and can result in severe loss of vision if not treated promptly. In our series the clinical and prognostic characteristics were considerably different between culture positive endoph- thalmitis cases and culture negative cases. RETINA 30:1051–1057, 2010 T he use of intravitreal antivascular endothelial growth factor (anti-VEGF) agents such as bev- acizumab (Avastin, Hoffmann-La-Roche Ltd., Basel, Switzerland) and ranibizumab (Lucentis, Novartis Inc., Basel, Switzerland) has increased dramatically during the past 2 years following reports of successful treatment for neovascular age-related macular degeneration, 1–6 diabetic macular edema, 7–9 macular edema secondary to retinal vein occlusion, 10,11 and others. One of the major complications associated with treatment is infectious endophthalmitis with a reported incidence ranging between 0.03% and 0.16% per injec- tion. 1,12–15 Given the increasing number of injections in clinical practice, the overall number of endophthalmitis cases can be expected to increase as well. Acute intraocular inflammation can also occur after intra- vitreal injection of bevacizumab, 16 and differentiation between that and infectious endophthalmitis is essential for appropriate therapeutic management. We report the clinical findings, causative organisms, management, and outcome of a small group of patients who From the *Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; and the †Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. None of the authors have any proprietary interest. Reprint requests: Adiel Barak, MD, Department of Ophthal- mology, Tel Aviv SouraskyMedical Center, 6 Weizman Street, Tel Aviv 64239, Israel; e-mail: omadb@post.tau.ac.il 1051