Date of Intake: 6-24-25
SOL: 9-2-2026
A 63-year-old male diabetic, received his first-ever bilateral Eylea HD (high-dose aflibercept) intravitreal injections on 9/24/2024. Within approximately 12 hours he developed catastrophic left-eye inflammation — ultimately confirmed by culture as bacterial endophthalmitis (Enterococcus faecalis). Despite emergency interventions including bilateral intravitreal antibiotics, vitrectomy, and lensectomy, the left eye sustained permanent total blindness (NLP — no light perception) with intraocular necrosis. As of the most recent records (April–July 2025), the left eye remains blind, painful, and aphakic, with consideration of enucleation ongoing.
Potential deviations?
1. Bilateral Same-Day First-Time Injections without staging
2. Possible breach in Sterile/Aseptic Technique
3. Use of Sample Vials for bilateral Injection
4. Diagnostic Uncertainty and Treatment Characterization v. Culture evidence
5. Undocumented Injection prep/technique at the original visit
Was the patient’s outcome was proximately caused by contamination at the time of the intravitreal injection, representing a departure from accepted sterile injection technique and protocol, resulting in catastrophic infectious endophthalmitis and permanent vision loss?
Files:
No questions yet!
Do you believe there might have been medical error?
if sterile technique was not used or betadine was not used then malpractice . bilateral not uncommon even first time . enteroccusalmost all go blind .
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
infections happen and every retina specialist has had them . you would have to sho break in sterile technique basically op report should be in chart . if not possible ??
What makes you a good expert for this case?
been doing this for 40 years and going strong
How often do you encounter cases similar to this one in your practice?
all the time i have seen this which is rare but not always malpractice you have to use 2 different vials for each eye .
Do you believe there might have been medical error?
It is unlikely that a lapse in the standard of care resulted in this patient’s poor outcome. Endophthalmitis after an intravitreal injection is a rare occurrence, but it is also a known and predictable risk of the procedure. If every case of infection after intravitreal injection represented a lapse in the standard of care, then every retina specialist in the world would be guilty of such a lapse, simply because infections can still occur despite proper antiseptic technique. The question of whether there was contamination during the injection is not the right question to ask there was clearly contamination, otherwise no infection would have occurred the question though is whether proper procedures were followed if they were, then the infection is not the result of a lapse of standard in care, but simply represents the bad luck of a rare but serious event.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
There is no doubt that the eye became infected as a result of the injection. But the question is whether a medical error caused the infection. The medical record would have to demonstrate a lapse in proper antiseptic technique to establish that as the cause. Without evidence in the record suggesting a deviation from proper antiseptic technique, there is no reason to believe a medical error occurred that caused the infection.
What makes you a good expert for this case?
I am a board certified and fellowship-trained vitreoretinal surgeon and retina specialist. I perform thousands of intravitreal injections every year and dozens every week.
How often do you encounter cases similar to this one in your practice?
Sadly, with enough injections, infection predictably occurs. The quoted rates are between one in 3000 and one in 5000. Any doctor or practice that performs enough of these procedures will inevitably encounter infections like the one suffered by this patient. I practice in a large group, and therefore see a endophthalmitis on roughly a monthly basis
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