Fulminant Endophthalmitis After Intravitreal Injection with Aflibercept Caused by Streptococcus mitis

Purpose: To report a case of fulminant Streptococcus mitis endophthalmitis after intravitreal injection of aflibercept. Methods: Retrospective case report Results: An 83-year-old man presented with acute painful vision loss in his left eye approximately 20 hours after intravitreal injection of aflibercept. His vision had decreased from a baseline of 20/100 to barely hand motion in the left eye at the time of evaluation. He underwent immediate tap and inject followed by pars plana vitrectomy with irrigation of the vitreous cavity and intravitreal injection of antibiotics. The corneal edema continued to worsen due to the infectious and inflammatory membranes/debris in the anterior chamber. Five days after vitrectomy, the left eye underwent another intravitreal injection with Vancomycin, followed by a short course of oral prednisone and a sub-tenon’s injection with Triamcinolone few days thereafter. Ultimately, a funneled retinal detachment was noted three weeks after presentation on B-scan and vision became no light perception. Conclusion: Exotoxin-producing Streptococcus mitis endophthalmitis can result in poor visual outcome through severe inflammatory reaction, fibrinous and cyclitic membrane formation, and tractional retinal detachment.