Recurrent fungal endophthalmitis after intravitreal injections of bevacizumab

Abstract

Purpose: We intend to describe an uncommon case of recurrent post-cataract fungal endophthalmitis after intravitreal injections of Bevacizumab.

Observations: A 73-year-old male, who underwent an uncomplicated cataract surgery 8 months ago, presented to our department with postoperative endophthalmitis 5 days after his fifth intravitreal injection (IVI) of bevacizumab for treatment of cystoid macula edema caused by central retinal venous occlusion 6 months ago. The visual acuity (VA) was 0.1 (20/200). The patient underwent an emergency pars plana vitrectomy. Culture of vitreous tap was negative. Eight weeks later, the patient presented again with recurrent endophthalmitis 2 days after his sixth IVI of bevacizumab. VA was hand motion. The patient was treated with an emergency anterior and posterior segment washout with intracapsular posterior intraocular lens (pIOL) extraction. Culture of pIOL revealed Saccharomyces cervisiae fungi in the capsular bag. Six months later, clinical findings were stable with no signs of intraocular inflammation, VA was 0.3 (20/60).

Conclusions and importance: we assume that this is a rare case of chronic late-onset post-cataract fungal endophthalmitis, which was activated by repeated intravitreal injections of Bevacizumab.

Keywords: Bevacizumab; Fungal endophthalmitis; Intravitreal injections; Saccharomyces cervisiae.

Fig. 1

Clinical and ultrasound findings at the first presentation showed a complete involvement of the posterior segment, Visual acuity 20/200; A. Vitreous haze and impaired fundus view, B. B-scan: dense vitreous opacities.

Fig. 2

Clinical and ultrasound findings, three weeks after intensive treatment, showed no signs of intraocular inflammation, Visual acuity 20/60; A. clear fundus view, B. clear B-scan image.