Sterile endophthalmitis appears as an infrequent complication of intravitreal injections and seems to develop mainly in the context of the off-label use of drugs that have not been conceived for intravitreous administration. The aetiology of sterile endophthalmitis, independently of the administered drug, remains uncertain and a multifactorial origin cannot be discarded. Sterile inflammation secondary both to intravitreal triamcinolone acetonide and to intravitreal bevacizumab share many characteristics such as the acute and painless vision loss present in the big majority of the cases. Dense vitreous opacity is a common factor, while anterior segment inflammation appears to be mild to moderate. In eyes with sterile endophthalmitis, visual acuity improves progressively as the intraocular inflammation reduces without any specific treatment. If by any chance the ophthalmologist is not convinced by the sterile origin of the inflammation, this complication must be treated as an acute endophthalmitis because of the devastating visual prognosis of this intraocular infection in the absence of therapy. 1. Introduction It was Rycroft in 1945 who first described the intravitreal injection of penicillin for the treatment of endophthalmitis [1]. Intravitreal injections give the opportunity of administering the drug straight where it is necessary. The vitreous cavity offers the great advantage of being a reservoir where high levels of drugs can be maintained for long periods, exceeding by far the concentrations obtained by the administration of drugs through other ways (i.e., topical, intravenous) and minimizing possible systemic side effects due to the small dose given and the little amount of drug that may escape from the eye into the systemic circulation. All these advantages and the presence of novel drugs designed specially for intravitreal use have produced an enormous increase in the number of intravitreal injections administered. The safety profile of intravitreal injections depends not only on the surgical technique, but also on the characteristics of the administered drug. Probably, the most feared and potentially devastating complication of intravitreal injections is endophthalmitis. Once the diagnosis of acute infectious endophthalmitis is suspected, vitreous tap for microbiological study and administration of intravitreal antibiotics must be done, while pars plana vitrectomy will be necessary in a subgroup of patients [2]. Prompt diagnosis and treatment of this entity are crucial for obtaining the best visual prognosis. On the other hand, certain
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