Complete and Early Vitrectomy for Sterile Endophthalmitis After Bevacizumab: A Case Series

Intravitreal anti-vascular endothelial growth factor injections are widely used for retinal disorders but may occasionally lead to sterile endophthalmitis, a condition that can be challenging to distinguish from infectious endophthalmitis. We describe a series of five patients who developed acute intraocular inflammation within 24-48 hours of receiving bevacizumab injections. These patients presented with decreased visual acuity and vitreous haze but reported minimal or no pain. All patients were managed urgently with pars plana vitrectomy according to the complete and early vitrectomy for endophthalmitis (CEVE) protocol, which included intraoperative antibiotic infusion and microbiological sampling. Cultures from the vitreous samples and the bevacizumab vial were negative. Following early vitrectomy, inflammation resolved in all patients, and visual acuity returned to baseline within 30 days. No postoperative complications were observed. None of the 38 additional patients who received injections from the same vial developed endophthalmitis. These findings support an immune-mediated, noninfectious mechanism for these cases and suggest that early vitrectomy within the CEVE framework promotes rapid resolution and favorable visual recovery. Continued vigilance and further research are warranted to refine management strategies for sterile endophthalmitis.