A Large Outbreak of Fulminant Bacterial Endophthalmitis after Intravitreal Injection of Counterfeit Bevacizumab.

Purpose: This study reports the findings in a large series of patients with acute bacterial endophthalmitis after intravitreal injection of bevacizumab (IVB) in two eye hospitals.

Methods: Medical records were reviewed for patients who presented with acute fulminant endophthalmitis in one or two eyes following intravitreal injection of bevacizumab from two separate batches in two eye hospitals.

Results: Twenty-eight eyes of 21 patients presented with acute endophthalmitis 12-48 hours after IVB injection. Cultures from the eyes and the vials were positive for E. coli and Citrobacter, each in one of the hospitals. All patients were initially treated with topical, intravitreal, and systemic antibiotics. Twenty-four eyes underwent pars plana vitrectomy. Best corrected visual acuity (BCVA) was 1.27 ± 0.89 logMAR before IVB injecti,on which decreased to 2.80 ± 0.45 LogMAR after presentation of endophthalmitis and 2.12 ± 0.97 logMAR three months after IVB injection. Final visual acuity was found to be no light perception in four eyes.

Conclusions: This large outbreak of E.coli and Citrobacter endophthalmitis occurred after intravitreal injection of counterfeit bevacizumab. Visual outcomes were very poor.