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Ayushi Gupta and Vishal Agrawal
This 24YO male has a known history of retinitis pigmentosa (RP) with long-standing stable vision loss. Vision was 20/50 OD and 20/200 OS.
Color photography OD shows classic RP findings, including mid-peripheral intraretinal pigment migration (bone spicules), narrowed retinal vessels, and a pale disc. Extensive optic disc drusen (ODD) are present and markedly hyperautofluoresce. OCT shows outer retinal and RPE atrophy. A large disc druse is noted in the superficial inner portion of the disc, with a hyperreflective margin, hyporeflective core, and posterior shadowing. Similar findings were noted in his left eye (not shown).
Learning Points:
ODD are refractile calcific concretions that form anterior to the lamina cribrosa. They are thought to be extruded extracellular calcified mitochondria and may be inherited as an autosomal dominant trait. In patients with RP, they are present in about 10% of eyes on fundus photography (Grover et al, Ophthalmology 1997;104:295-298) and in 30% on EDI-OCT (Steensberg et al, J Neuroophthalmol 2024;44:483-487). ODD in isolation can cause progressive visual field defects or central vision loss, which can often confound assessment of RP-related vision loss.
Retina. 2026 Sep 1;46(9):1486-1491. doi: 10.1097/IAE.0000000000004855.
Post-intravitreal injection endophthalmitis incidence 0.0072% at BPEI — Retrospective, 2021-2025
Purpose: To report the rates, culture results, and visual acuity outcomes of endophthalmitis after intravitreal injection.
Methods: Retrospective, consecutive case series of all patients who underwent intravitreal injection at University of Miami-Bascom Palmer Eye Institute between January 1, 2021, and December 31, 2025.
Results: Endophthalmitis occurred following intravitreal injection in 3/28,358 (0.011%) eyes in 2021, 3/24,918 (0.012%) in 2022, 3/24,840 (0.012%) in 2023, 1/28,831 (0.003%) in 2024, and 0/31,269 in 2025 (0%). The use of ranibizumab decreased with time in the current study while faricimab usage increased. There was a slight increase in aflibercept usage after the approval of high dose 8 mg aflibercept in 2023. Complement inhibitors pegcetacoplan and avacincaptad pegol, approved in 2023 for geographic atrophy, were administered in 1,894 and 423 eyes, respectively, in 2024, and 1,083 and 578 eyes, respectively, in 2025; no cases of endophthalmitis were associated with either agent. Vitreous cultures demonstrated growth of Streptococcus mitis/oralis in 1/10 (10%), Staphylococcus aureus in 1/10 (10%), Granulicatella adiacens in 1/10 (10%), Staphylococcus epidermis in 1/10 (10%), Abiotrophia defectiva in 1/10 (10%), and were negative in 5/10 (50%). The cumulative incidence of endophthalmitis over the 5-year time period was 0.0072% (10/138,216) and was similar to rates reported between 2005 and 2020 at the same institution (P = 0.18). There were no differences in the rates of endophthalmitis between various medications (P = 0.32). After treatment, mean best-corrected visual acuity at last follow-up examination was 1.42 logMAR (20/526; range: 20/20 to no light perception).
Conclusion: Endophthalmitis is a rare complication of intravitreal injection. In this study, the incidence of endophthalmitis was similar to previously reported rates and did not differ between agents.
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