ACUTE ATYPICAL ENDOPHTHALMITIS FOLLOWING INTRAVITREAL SUSTAINED-RELEASE DEXAMETHASONE IMPLANT: A CASE SERIES.

Purpose: To present three cases of acute endophthalmitis following intravitreal sustained-release dexamethasone (Ozurdex) with atypical presentation and to discuss the management of these patients.

Methods: A retrospective case series of three patients with endophthalmitis following intravitreal sustained-release dexamethasone (Ozurdex) implantation who presented between July 2020 and August 2020.

Results: Two of three patients who were treated with topical steroid and antibiotic therapy alone showed favorable outcomes and were managed without the need for intravitreal antibiotics or implant removal. One patient who showed initial response to topical therapy subsequently required pars plana vitrectomy, implant removal, and a single empirical dose of intravitreal antibiotics and antifungal agent due to persistent inflammation.

Conclusion: Postintravitreal Ozurdex endophthalmitis, although a rare entity, can present with atypical features of a painless white eye and a delayed onset intraocular inflammation. Although all cases of endophthalmitis should be treated as infective until proven otherwise, it is fair to consider a trial of conservative treatment with topical steroids and antibiotics initially with close monitoring. In cases with poor response to topical therapy, pars planar vitrectomy and implant removal should be strongly considered.