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When you suffering from AMD, you need to seek treatment immediately to save your vision. Unfortunately a possibility of having a needle go into your eye is the risk of infection. This condition is termed endopthalmitis and can be also very dangerous.

Wet age-related macular degeneration is a dangerous condition that needs immediate intervention to save the vision of the patient. Anti-VEGF has become a "gold-standard" therapy option for patients to reduce the number of blood vessels that grow on the macula to help preserve visual acuity and in essences, save the vision of the patient for the long-term [1]. Unfortunately, there are some inherent risks that patients agree to when they are deciding to do this type of therapy and some of the macular degeneration treatment side effects can be quite difficult for patients to manage [2]. One of the possible side effects would be eye infections after intravitreal injection which could dramatically complicate further injections. 

How do you Get an Intravitreal Infection? 

One of the unavoidable risks of injecting fluids into your eyes is the possibility of infections in your inner eye referred to as endophthalmitis when getting macular degeneration treatment. Even if you are doing these anti-VEGF therapies to help preserve your vision, endophthalmitis has the possibility to cause vision loss as well and will also come with severe pain, red eyes and eyelid swelling. An unfortunate thing about the anatomy of the eye is the fact that it is a protected environment from bacteria due to the compartmentalization of eye chambers only. Due to this, it is hard for bacteria to penetrate the eye and we protect our vision without much effort from our own immune system but when foreign antigens are introduced into the eye, bacteria can easily thrive without any real immune response to come to defend the eye. This is exactly what happens when you get inflammation after intravitreal injections as bacteria catches a ride on the needle and enters the vitreous fluid of the eye, causing extensive inflammation. [3]

Thankfully, due to improvements in sterilization techniques and physician experience, the incidence of endophthalmitis is very low. In one study, patients receiving anti-VEGF therapy were analyzed for a period of 6 years to determine the likelihood of the patients developing this endophthalmitis and only 7 out of 22,674 patients (0.004 percent) developed infections of this nature. The main bacteria that was responsible for this type of infection was Staphylococcus epidermidis, a bacteria covering the surface of our skin and can be transferred easily when even having close contact with patients. [4]

Medically speaking, this is a very acceptable risk rate in patients and should prove to you already that we are speaking of very rare events if you choose to undergo anti-VEGF therapy. You should not let the risk of complications of infections prevent you from seeking intravitreal injections. 

What are your Treatment Options for Intravitreal Infections? 

Let's say you are one of the few unlucky individuals that ultimately develop this eye infection after intravitreal injections. You are now presented with a whole new pathology to worry about and you find yourself in a race against the clock in order to save your vision. Depending on the severity of the inflammation, you may have either need urgent medications or require a surgical procedure to save your vision. [5]

In most cases, the history and the symptoms associated with your eye inflammation are enough to warrant a diagnosis of endophthalmitis but in some cases, more extensive diagnostic tests may be done to ensure you are suffering from this disease. You could culture the eye directly to determine what organisms are infecting the eye but this proves to be more tricky than you'd assume because of the high rate of false positive or false negatives. It is a test that can be easily contaminated so it will not be the most conclusive investigation to preform. [6] If you were to sample the vitreous fluid directly with a vitrectomy, it will give you an accuracy of nearly 92 percent [7]. In most cases, though, you are wasting time trying to determine what is the root cause of your problems so most doctors will choose to treat the inflammation aggressively with antibiotics or surgery without even knowing the real cause of the infection. 

Although we don't have concrete guidelines to tell us how quickly antibiotics need to be in your eyes in order to be most effective, studies indicate that patients receiving antibiotic therapy within 24 hours of noticing eye inflammation tended to have better prognoses than those who waiting longer to get treatment [8]. Most patients will receive vancomycin antibiotic therapy which may be changed later on if it is determined that the medication is not working. 

An alternative approach if antibiotics are not available or not effective would be to have a surgical procedure to drain the vitreous fluid to "vacuum out" the bacteria causing an infection. This type of vitrectomy is used both to diagnose and to treat the condition and patients respond within a matter of hours typically [9]. 

Prognosis factors depend almost exclusively on how quickly patients start their therapy once they notice eye infections after intravitreal injection. Patients could lose their vision if they wait after a long-period of time to begin therapy but if it you are well-controlled, vision acuity should return in a few days. [10]

All in all, just remember that when you are suffering from macular degenerationmacular degeneration treatment side effects are possible but they are so unlikely, that they are not enough to deter you from getting this therapy. Do not alter your macular degeneration treatment just because of fear. 

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