Bacterial and sterile endophthalmitis after intravitreal injections, treatment options and outputs: literature review

Ieva Kunickaitė1

1Vilnius University, Faculty of Medicine, Vilnius, Lietuva


Introduction. In the last 2 decades, vitreous injections have become increasingly used in treatment of intraocular diseases, especially posterior segment disorders. It is estimated that 5.9 million of these injections were performed in the United States alone in 2016, and that number is growing at least 10% annually. Acute bacterial or sterile endophthalmitis can occure after intravitreal injections.

Aim. Based on the latest scientific literature, summarize and present information on the occurrence of bacterial and sterile endophthalmitis after vitreous injections, treatment options and outcomes.

Methods. The literature review was performed using PubMed and ScienceDirect databases. Scientific articles were analyzed by keywords and their combinations: bacterial endophthalmitis, sterile endophthalmitis, intravitreal injections. Exclution criteria were applied to articles related to fungal endophthalmitis. 23 publications were examined. Only articles written in English were selected.

Results. ​​The incidence of endophthalmitis of vascular endothelial growth factor inhibitors (anti-VEGF) is 0,131%. The incidence of sterile endophthalmitis after intravitreal injections is uncommon, ranging from 0.09% to 1.1%. The primary treatment for endophthalmitis is vitreous injection of antibiotics and / or pars plana vitrectomy (PPV).

Conclusions. The main clinical differences between bacterial and sterile endophthalmitis are the onset of endophthalmitis (bacterial usually occurs more than 3 days after intervention and sterile within the first 3 days) and the absence of eye pain in sterile endophthalmitis. It has been reported in the literature that sterile endophthalmitis usually resolves spontaneously, but antimicrobial therapy with PPV is used as the disease progresses.


Keywords. Bacterial endophthalmitis, sterile endophthalmitis, intravitreal injections.