An outbreak of endophthalmitis following Intravitreal Injection of Bevacizumab in a referral center

Purpose to- Report the largest outbreak of infectious endophthalmitis after intravitreal injection (IVI) of bevacizumab (BCZ) from a single-use vial to 14 Libyan patients. Design- A retrospective non-comparative case series. Methods- Medical records and microbiology results of 13 out of 14 endophthalmitis patients who were injected with BCZ on two consecutive days September 3 and September 4, 2019, were reviewed. Results – Fourteen patients were injected by four physicians on 2 consecutive days with BCZ, prepared by a well-trained operation theatre (OT) nurse at the major operation theatre in Alkeish polyclinic under aseptic technique. All of them presented the next day with signs and symptoms of endophthalmitis, (13 out of 14 patients) were treated by intravitreal antibiotic injections as an emergency measure and they underwent PPV within 5-7 days. Microbiology results revealed that Acinetobacter baumannii was the organism responsible for the infection. After one month of the incident; One patient (7.5%) recovered vision of 6/24, four patients (31%) had a vision of 6/60, but eight patients (61.5%) did not recover their vision and had a vision of count-fingers and less. Conclusion- The unavailability of a single-use ampule of BCZ and its compounding from a larger volume vial is a risk that mandates following the standard guidelines for IVI for the prevention of complications.