Early clinical characteristics of bacterial endophthalmitis in retinopathy of prematurity after intravitreal bevacizumab injection: A case report

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Abstract
Intravitreal bevacizumab injection (IVB) is emerging as a safe and effective therapy for retinopathy of prematurity (ROP); however, follow‑up investigations after IVB have indicated that endophthalmitis, a rare and devastating complication, may develop. The present study reports a case of an infant with ROP who developed endophthalmitis after IVB infection. The infant was administered with an intravitreal injection of broad‑spectrum antibiotics to treat the endophthalmitis. A favorable anatomic outcome was achieved after follow‑up. From this case, it was discovered that the early clinical characteristics of endophthalmitis infection secondary to IVB in premature infants include: i) The clinical symptoms of endophthalmitis infection appearing as early as 3‑5 days after IVB; ii) a white membranous plaque on the retina surface with an obscure circular boundary; iii) a plaque that enlarges to a gray flocculent mass and intrudes the vitreous body, where the hazing surrounds the lesion; and iv) conjunctival hyperemia and cornea edema in the anterior segment of the affected eye. This case also indicated that timely retinal screening with RetCam or a binocular ophthalmoscope 3‑5 days after IVB may be effective for detecting early stage endophthalmitis in infants who are unable to complain of a loss of visual acuity. From the present case report, it is advisable that the same type of screening be performed 3‑5 days after other types of eye surgery, such as cataract extraction surgery, to detect early stage endophthalmitis. Furthermore, the present case also revealed that an early intravitreal injection of broad‑spectrum antibiotics may be an effective treatment for premature infants with bacterial endophthalmitis.

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