Simultaneous Bilateral Vitrectomy for Bilateral Acute Endophthalmitis after Intravitral Bevacizumab Injection

Purpose: To report a case of acute endophthalmitis after intravitreal bevacizumab (IVB) injection and simultaneous bilateral pars plana vitrectomy as treatment. Methods: A 68 years old poor controlled diabetic patient with history of IVB four days before, due to diabetic macular edema, was presented with bilateral ocular pain and reduced vision. Hypopyon, corneal edema, fibrin membrane on the lens, and cataract was obvious in slit lamp exam. In ultrasonography, diffuse vitreous involvement was documented. Visual acuity was declared to reduce since the day before referring and at presentation was hand motion. Findings were similar in both eyes. Results: Bilateral pars plana vitrectomy and lensectomy, and triamcinolone assisted posterior vitreous detachment induction was performed bilaterally. Peripheral occluded vessels and fibrin formation on retina was seen. Macula was edematous with large hard exudates. Endolaser-phtocoagulation and silicone oil tamponade was used. The day after operation, pain was reduced and red reflex was good. One week after, uncorrected visual acuity was improved to counting finger half meter. Culture result was pseudomonas aeruginosa. Forbilateral injection, a same vial of bevacizumab (Avastin; Roche, Basel, Switzerland) was used. Conclusion: Although rare, endophthalmitis is a hazardous consequence of intravitreal bevacizumab injection. Hence, it seems better to avoid using same Avastin vial for bilateral injection.