Post-Ranibizumab injection endophthalmitis in aggressive posterior retinopathy of prematurity

Abstract

A preterm infant with zone 1 aggressive posterior retinopathy of prematurity developed infectious endophthalmitis after intravitreal injection of ranibizumab. Urgent empirical intravitreal therapy with vancomycin, ceftazidime, and dexamethasone along with intravenous therapy with amikacin and meropenem helped in early resolution. Vascularization/activity of disease subsided on follow-up, media cleared, and laser photocoagulation was completed. Later the disease reactivated, developed vitreous membranes and central retinal traction, for which 25-gauge lens-sparing vitrectomy was performed. Emergent treatment helped in salvaging the eye from both aggressive ROP disease and devastating endophthalmitis. Rationale approach to such a case is being discussed.

Keywords: Endophthalmitis; ranibizumab; retinopathy of prematurity; vascular endothelial growth factor.

Figure 1

Course of disease in the left eye of an infant with aggressive posterior retinopathy of prematurity who developed infectious endophthalmitis after intravitreal ranibizumab injection. (a) Fundus photograph shows signs of resolving endophthalmitis/vitritis at day 6 after injection (35 weeks). (b) At 42 weeks following laser photocoagulation, media had cleared with resolved neovascularization with minimal central retinal traction. (c) At 48 weeks, retinopathy of prematurity reactivated with severe worsening of central vitreoretinal traction. (d) Post lens-sparing vitrectomy (55 weeks), retinal traction had reduced in height with resolving preretinal hemorrhage and central macular pucker

Figure 2

(a) At 37 weeks, the right eye shows zone 1 aggressive posterior retinopathy of prematurity with severe plus disease and avascular loops. (b) At 42 weeks, neovascularization had regressed following complete laser photocoagulation with minimal central retinal traction