Endophthalmitis Caused by α-Streptococcal Following Intravitreal Ranibizumab Biosimilar Administration Using a Prefilled Syringe

TL;DR

A rare case of α-streptococcal endophthalmitis following a biosimilar ranibizumab injection was successfully treated with urgent vitrectomy and antibiotic irrigation.

Contribution

This case highlights the rare occurrence of α-streptococcal endophthalmitis following biosimilar drug administration and successful treatment with ceftazidime and vancomycin.

Findings

α-Streptococcal was isolated from both aqueous humor and vitreous cultures.

Urgent vitrectomy with ceftazidime and vancomycin irrigation led to visual recovery.

Postoperative visual acuity returned to pretreatment levels within 19 days.

Abstract

Endophthalmitis continues to represent a vision-threatening complication of intravitreal injection. Herein, we present a rare case of endophthalmitis caused by α-streptococcal following intravitreal ranibizumab biosimilar administration using a prefilled syringe. A 72-year-old woman was referred to our clinic and diagnosed with acute endophthalmitis in the left eye, following intravitreal administration of a ranibizumab biosimilar delivered via a prefilled syringe. A hypopyon was noted at a height of 3 mm, and the fundus examination of the left eye was obscured by corneal edema. The best-corrected visual acuity (BCVA) in the left eye was limited to hand motion. Urgent vitrectomy was performed with intraoperative irrigation using ceftazidime sodium (20 mg/500 mL) and vancomycin (10 mg) in the left eye. α-Streptococcal was isolated from both the aqueous humor and vitreous culture specimens. At 19 days postoperatively, the fundus was clearly visible, and the BCVA had recovered to 0.4 in the left eye, which corresponded to the pretreatment level. Urgent vitrectomy with irrigation using ceftazidime sodium and vancomycin may facilitate visual recovery in the affected eye.

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