Bleb-associated infections after intravitreal injection

Purpose: The purpose of this study was to describe two cases of bleb-associated infections after intravitreal injection. Methods: Case reports of two patients. Case 1: A 41-year-old man with choroidal neovascular membrane received intravitreal injections of ranibizumab. Case 2: A 56-year-old man with cystoid macular edema after retinal detachment surgery received intravitreal triamcinolone acetonide. Results: In Case 1, the patient developed a culture-negative blebitis 3 days after intravitreal ranibizumab and was treated with intravitreal, subconjunctival, and oral antibiotics. The infection resolved after 3 weeks, with stable 20/100 vision and preservation of bleb function. In Case 2, a bleb-associated endophthalmitis (positive for Streptococcus pneumoniae) occurred 3 weeks after intravitreal triamcinolone acetonide, requiring repeated intravitreal antibiotics and two vitrectomy procedures to control the infection, with final vision of hand motions. Conclusion: Bleb-associated infections can be a complication of intravitreal injection. The potentially severe results of bleb-associated endophthalmitis warrant monitoring in patients with previous trabeculectomy who undergo intravitreal injection therapies.