Endophthalmitis After Dexamethasone Implant

BACKGROUND: The dexamethasone intravitreal implant is used to treat sight-threatening retinal disorders. Endophthalmitis is a serious complication of intravitreal injections and requires urgent intervention. Recent evidence demonstrates that the dexamethasone implant has higher endophthalmitis rates than some intravitreal injections. We present a large, prospective, state-wide analysis. METHODS: The Victorian Endophthalmitis Registry prospectively identified all dexamethasone implant-related endophthalmitis cases from January 2018 to June 2024 in Victoria, Australia, managed at the Royal Victorian Eye and Ear Hospital, a state-wide service. The Pharmaceutical Benefits Schedule Item Reports available on the Medicare Australia database were used to determine the number of dexamethasone implants in Victoria, Australia, to calculate the incidence rate of dexamethasone implant-related endophthalmitis. RESULTS: Fifteen incidences from 9457 implants resulted in endophthalmitis (rate = 0.16%, 1 in 630 injections). All cases received inpatient care with an aqueous and vitreous tap, intravitreal vancomycin, and ceftazidime. Fourteen cases (93%, n = 15) underwent surgical intervention, including 13 cases of vitrectomy (87%, n = 15). A causative pathogen was isolated in 86.7% of vitreous samples (n = 13/15), with Staphylococcus epidermidis being the most common, found in seven eyes (46.7%, n = 15). Three eyes (20%, n = 15) underwent enucleation. The remaining 12 eyes had a mean follow-up visual acuity of Snellen 6/27 (logMAR 0.65 ± 0.43). CONCLUSIONS: The rate of dexamethasone implant-related endophthalmitis is 0.16% which is higher than other intravitreal injections reported in the literature, with considerably poor visual outcomes. The vitreous diagnostic samples are culture-positive in 87% of cases (13/15), with 46.7% (7/15) isolating Staphylococcus epidermidis .