Culture-Proven Haemophilus influenzae Endophthalmitis After Intravitreal Topotecan for Retinoblastoma

Abstract

Purpose: To describe the management and clinical outcome of severe infectious endophthalmitis after intravitreal (IVT) topotecan injection for retinoblastoma in an eye with potential vision. Methods: A single case was reviewed. Results: An 8-month-old child with bilateral retinoblastoma receiving systemic chemotherapy developed acute endophthalmitis in the only eye with potential vision 3 days after the sixth IVT topotecan injection. Urgent 23-gauge pars plana vitrectomy was performed to clear dense vitritis and maintain oncologic control using a closed-system approach, melphalan irrigation (5 µg/mL), IVT topotecan, port-site cryotherapy, and silicone oil tamponade. The patient also received IVT vancomycin, ceftazidime, and voriconazole. Vitreous culture identified Haemophilus influenzae . The infection resolved, the tumor continued to regress, and no extraocular tumor spread was observed during 24 months of follow-up. Conclusions: Early, tailored vitrectomy may help preserve vision in severe endophthalmitis after IVT chemotherapy for retinoblastoma when strict oncologic precautions are maintained, with long-term follow-up required to monitor for tumor recurrence or extraocular spread.