Introduction:

Intravitreal injections have revolutionized the treatment of various retinal diseases, but they can occasionally lead to complications, such as sterile endophthalmitis. This article delves into the phenomenon of sterile endophthalmitis following intravitreal injections, exploring its causes, clinical presentation, and management strategies.

Understanding Sterile Endophthalmitis:

Definition:

• Sterile endophthalmitis is an inflammatory reaction within the eye following an intravitreal injection that lacks evidence of microbial infection.
• It is characterized by the sudden onset of inflammation in the anterior and/or posterior segments of the eye.

Causes:

• The exact cause of sterile endophthalmitis remains debated, but it is thought to be related to the introduction of contaminants during the injection procedure.
• Non-sterile equipment, inadequate disinfection, and improper handling of medications can contribute to the development of sterile endophthalmitis.

Symptoms and Clinical Presentation:

• Patients may experience sudden pain, redness, blurred vision, and increased floaters in the affected eye.
• The anterior segment may show signs of inflammation, such as conjunctival injection and anterior chamber cells.
• In the posterior segment, vitritis, haze, and macular edema may be observed.

Diagnosis:

• Clinical evaluation, including a detailed patient history and thorough ocular examination, is crucial in diagnosing sterile endophthalmitis.
• Laboratory tests, such as vitreous tap and culture, are usually negative for microbial growth.

Management:

Observation:

• Mild cases of sterile endophthalmitis may resolve on their own without intervention.
• Close monitoring of the patient's symptoms and clinical progression is essential.

Topical and Oral Medications:

• Topical corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) can be prescribed to reduce inflammation and discomfort.
• Oral antibiotics may be used to prevent secondary infections.

Vitrectomy:

• In severe cases, vitrectomy (surgical removal of vitreous gel) may be considered to alleviate inflammation and improve visual outcomes.

Prevention Strategies:

Proper Aseptic Technique:

• Adherence to strict aseptic technique during the injection procedure is crucial to prevent the introduction of contaminants.
• The use of sterile gloves, drapes, and pre-injection antisepsis helps minimize the risk of sterile endophthalmitis.

Medication Handling:

• Proper storage, preparation, and handling of intravitreal medications can significantly reduce the risk of contamination.
• Using medications from reputable sources and avoiding expired or compromised vials is essential.

Patient Education:

• Educating patients about the signs and symptoms of complications after intravitreal injections empowers them to seek prompt medical attention.

Conclusion:

Sterile endophthalmitis following intravitreal injections, although rare, can lead to significant visual morbidity. Timely recognition, appropriate management, and rigorous prevention strategies are crucial to minimizing the occurrence of this inflammatory reaction. By adhering to proper aseptic techniques, ensuring medication handling compliance, and educating both patients and healthcare providers, the risk of sterile endophthalmitis can be mitigated, allowing patients to benefit from the therapeutic potential of intravitreal injections safely.

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