NOVEL CASE OF CLOSTRIDIUM PERFRINGENS ENDOPHTHALMITIS AFTER ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTION

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Abstract

Introduction:

Endophthalmitis after anti–vascular endothelial growth factor injection is a rare complication but may lead to rapid destruction of structures within the eye. Infection with Clostridium perfringens has not previously been reported in this context.

Case Report:

A 90-year-old woman presented with endophthalmitis of the right eye, 2 days after an intravitreal injection of ranibizumab. Initial examination showed a high intraocular pressure, refractive to topical treatment, reduced vision, and a hypopyon. Gram stain showed a Gram-positive bacillus, which was identified as C. perfringens. Despite the use of intravitreal and intravenous antibiotics, the patient went on to develop cornea-scleral melt of the right eye. She required an evisceration on the fifth day after ranibizumab.

Conclusion:

This case describes a unique and virulent pathogen leading to globe loss after an anti–vascular endothelial growth factor injection. C. perfringens, naturally living in feces or soil, is more commonly associated with dirty traumatic open-globe injuries. However, it is an important pathogen to consider when there is rapid destruction of eye structures associated with endophthalmitis. Based on a root cause analysis of this case, our department has introduced patient information leaflets on hand hygiene to educate patients having intraocular injections.

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