Medical management of a subretinal Klebsiella pneumoniae abscess with excellent visual outcome without performing vitrectomy.

OBJECTIVE: To report the case of a Klebsiella pneumoniae endogenous endophthalmitis (KPEE) of hepatic and urinary origin that was successfully treated with systemic antibiotherapy and 13 intravitreal antibiotics injections without performing a vitrectomy. PATIENT AND METHOD: Case report of a 60-year-old man with a subretinal abscess in the left eye that developed 3 days after initial presentation for K. pneumoniae bacteremia, liver abscess and urinary tract infection. RESULTS: Ophthalmic examination of the left eye showed anterior uveitis and a single subretinal abscess located in mid-peripheral temporal retina. BCVA dropped to 20/50. Follow-up was made with clinical examination and multimodal imaging (SD-OCT, FA, ICGA) with high field photographs. A total of 13 intravitreal injections (IVI) of ceftazidime were performed, and no vitrectomy was required. Ocular signs regressed and prognosis was excellent with 20/20 of final BCVA. CONCLUSION: KPEE is a rare but severe condition with a typically poor ocular prognosis. When diagnosis is made early, subretinal abscess with partially conserved BCVA could be treated successfully with medical management that includes systemic antibiotics and repeated intravitreal injections without requiring vitrectomy.

[Incidence of endophthalmitis after intravitreal injection: is antibioprophylaxis mandatory?]. / Incidence de l'endophtalmie après injection intravitréenne : peut-on se passer de l'antibioprophylaxie ?

INTRODUCTION: Endophthalmitis is the most dreaded complication after intravitreal injection. With the rise of antiangiogenics their rate is getting higher each year. The use of antibioprophylaxis is controversial. We tried to evaluate the impact of antibioprophylaxis on intravitreal injection endophthalmitis incidence. METHODS: All patients who received intravitreal injections between January 2007 and October 2012 were included in this retrospective study. Until June 2012 all patients had antibiotics the days following the injection. From July 2012 the antibiotic was replaced by an antiseptic immediately after the injection. RESULTS: An overall number of 11,450 injections were performed. The overall rate of endophthalmitis was 6/11,450 (0.052%). The incidence of endophthalmitis in the group with antibiotics was 3/10,144 injections (0.03%), 2 were culture proven (0.02%). The incidence in the group without antibiotics was 3/1306 (0.23%). The difference was significant (P=0.024). CONCLUSION: The incidence of endophthalmitis post-intravitreal injections seems to be lower when using antibiotics. However, a prospective study is mandatory to draw more robust conclusions.

[Treatment of high myopic choroidal neovascularisation with intravitreal bevacizumab]. / Traitement des néovaisseaux choroïdiens du myope fort par injection intravitréenne de bevacizumab.

PURPOSE: To evaluate the safety and efficacy of intravitreal bevacizumab (IVB) in the treatment of high myopic choroidal neovascularization (CNV). MATERIALS AND METHODS: Retrospective study of 16 eyes of 16 patients with high myopic choroidal neovascularization treated with first-line IVB (1.25mg/0.05mL) with a one-year follow-up. All patients underwent a complete baseline (M0) ophthalmologic examination, including the measurement of best corrected visual acuity (BCVA), biomicroscopic and fundus examination, fluorescein and indocyanine green angiography, and optical coherence tomography. Patients were followed monthly. Additional IVB was administered when persistent or additional retinal exudation was observed. The main study parameters were visual acuity at 1, 6 and 12 months and the progression of exudation on OCT and angiography. RESULTS: Mean age was 63±14 years and spherical equivalent was -15.4±7.4 diopters. Baseline BCVA was 0.75±0.5 logMAR. Mean follow-up was 15±2 months. The average number of IVB was 2.4±1.2 injections. Metamorphopsia decreased in all patients and completely disappeared in fourteen eyes. Mean BCVA was 0.5±0.3 logMAR at M1 and 0.6±0.5 logMAR at M6 and M12. No adverse events related to the intravitreal injections were observed. CONCLUSION: Our study showed that IVB (Avastin(®)) is effective in the treatment of high myopic CNV. Moreover, only a small number of intravitreal injections were required to treat this condition.