Sterile Endophthalmitis after Intravitreal Aflibercept Injection: Clinical Characteristics and Therapeutic Outcomes

Purpose: To report the clinical characteristics and visual prognosis of patients with sterile endophthalmitis following intravitreal aflibercept injection.Methods: We retrospectively reviewed the medical records of patients diagnosed with sterile endophthalmitis after intravitreal aflibercept injection.Clinical manifestations, visual outcomes, and therapeutic effects of steroids were evaluated.Results: Sterile endophthalmitis occurred in 13 of 2,582 eyes (0.5%) and in 10 of 437 patients (2.29%).The mean time to diagnosis was 2.5 0.5 days (range, 2-3 days) after injection.Four of the 10 patients presented with blurred vision but had no ocular pain, conjunctival injection, or hypopyon.All affected eyes exhibited anterior chamber inflammation (SUN grade: 1.29 0.49), and 11 eyes showed vitritis (SUN grade: 1.38 1.04).The mean best-corrected visual acuity (logMAR) was 0.26 0.34 before injection, decreased to 0.49 0.45 at the time of diagnosis, and recovered to 0.28 0.29 after treatment.One eye required vitrectomy, intravitreal antibiotics, and vitreous culture, which was negative for infection.The remaining 11 eyes were managed with topical and systemic corticosteroids.Complete resolution was achieved in all patients within an average of 15.6 days.One patient experienced three recurrences despite pre-injection use of topical or oral steroids.Conclusions: Sterile endophthalmitis after intravitreal aflibercept injection typically presents with delayed-onset, mild, painless intraocular inflammation.Oral corticosteroids can be effective in reducing symptom duration after excluding infection.Routine follow-up visits 2-3 days post-injection can aid in early detection and appropriate management.