Outcomes of Endophthalmitis Outbreak 2023 in Pakistan

Background: Endophthalmitis is a severe eye infection that can occur after intravitreal Bevacizumab injections, often due to contamination or poor aseptic techniques. Our Eye Center managed most cases from a recent provincial outbreak. This study analyses clinical and microbiological characteristics of endophthalmitis. Methods and Results: This Prospective cross-sectional study included twenty-six eyes of 20 patients who developed acute endophthalmitis following intra-vitreal injections of Bevacizumab. After taking informed consent, detailed ophthalmic examination along with pain scoring and clinical photographs were obtained from every patient. All patients underwent Pars Plana Vitrectomy and anterior chamber lavage with injection Meropenum. Some patients also had to undergo conjunctival flap or tectonic graft surgical procedures. All patients were given standard antibiotics for endophthalmitis in addition to topical as well as systemic Meropenum. Pain and visual acuity were taken as outcomes of this study. Mean age recorded was 54.4±11.77 years (Range 33 to 70 years) with male: female ratio of 1:1.8. Vitreous tap for culture analysis revealed Pseudomonas aeruginosa in 13 cases (65%). Mean visual acuity at the time of presentation was 2.80±0.24 that improved to 2.71±0.24 at 1 month while pain score also improved from 2.55±3.23 to 0.45±1.60 with significant p-values. Early pars plana vitrectomy (PPV) was performed in 11 patients (55%), demonstrating notable enhancements in both visual acuity and pain relief, while late PPV yielded less substantial outcomes in the remaining 9 patients (45%) clinically but statistically the difference in outcomes between two groups was not significant. Conclusion: Bevacizumab dispensed through compounding pharmacies can have devastating outcomes if standard protocols are not followed. Pseudomonas aeruginosa was the major causative agent which can be transmitted during transportation. Early PPV along with systemic, topical and intra-cameral meropenum was found to be effective in controlling pain and improving visual outcome.