Purpose: To describe morphologic changes on optical coherence tomography angiography (OCTA) in 4 eyes with exudative neovascular age-related macular degeneration (nAMD) after a switch in treatment from aflibercept to faricimab. Methods: A total of 4 eyes from 3 patients were evaluated. Results: Three patients (4 eyes) with nAMD were included. Treatment was switched to faricimab due to inadequate control of exudation or limited treatment interval extension with other antivascular endothelial growth factor (anti-VEGF) therapies. All eyes showed morphologic changes in macular neovascularization (MNV) on OCTA after the switch from aflibercept to faricimab. The MNV trunk persisted in all eyes, with regression of the lacy vasculature after treatment. Despite residual MNV, exudation was well controlled in all eyes at 9- to 11-week treatment intervals. Notably, morphologic changes were seen on OCTA even when structural findings remained largely unchanged. Conclusions: Long-term faricimab therapy is associated with distinct morphologic changes in MNV seen on OCTA that were not observed with other anti-VEGF therapies, highlighting the added value of OCTA for assessing treatment response.

PURPOSE:Knobloch syndrome is a rare autosomal recessive condition characterized by lack of functional collagen type XVIII (COL18A1), occipital defects, high myopia, and vitreoretinal degeneration. Clinical features, retinal detachment (RD) rates, and role of prophylactic treatment are not well established. The purpose is to 1) report clinical/systemic features, 2) RD rates and 3) the role of prophylactic treatment in a U.S.-based genetically confirmed cohort. DESIGN:Retrospective, nonrandomized multi-center case cohort SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Genetically confirmed Knobloch patients from 12 US -based pediatric retina tertiary referral centers MAIN OUTCOMES MEASURES: Baseline characteristics, RD rates, risk of RD with or without a history of prophylactic treatment RESULTS: 72 eyes (36 patients) were included. Mean follow up was 5.2 years. 14 patients (38.9%) were female. Most common systemic features included 1) occipital defects (n=17 (47.2%)), 2) intracranial abnormalities (n=10 (27.8%); polymicrogyria, plagiocephaly, cortical dysplasia, encephalomalacia, periventricular heterotopia), and 3) skin (n=5 (13.9%)); hemangioma, eczema). Mean +/-SE refractive error was - 9.85 (range -20.12 - +7.50). 18 eyes (25.0%) had cataracts, 16 (20.0%) iris defects (transillumination defects, absent crypts, pupillary membrane), 40 (57.1%) optically empty/vitreous condensations, and 64/70 eyes (91.4%) had macular abnormalities ranging from tessellated fundus to generalized macular atrophy.Of 72 eyes, 23 (31.9 %) experienced an RD, 12 (52.2%) at baseline. Two eyes (8.7%) had a concurrent macular hole. Mean age at RD was 6.24 years and time to RD was 18.6 months (0 - 86). 20 eyes (87.0%) underwent RD surgery (laser, SB, PPV, or PPV/SB). Single and final anatomic success was 60% and 85%. 21/72 eyes (29.2%) received laser or scleral buckle prophylaxis - only two of which (9.0%) developed an RD. Age-adjusted GEE logistic model demonstrated lower odds of RD in eyes that received prophylaxis than not (OR 0.20, P = 0.022). 4/19 fellow eyes (21%) developed an RD (n=1 with previous RD prophylaxis). There was a nonsignificant lower odds of RD in fellow eyes that received RD prophylaxis versus no prophylaxis (OR = 0.42, p = 0.41). CONCLUSION:In genetically confirmed Knobloch, RD rates are high, and RD prophylaxis appeared to reduce risk of RD. Early diagnosis and prophylaxis should be considered in this population.

PURPOSE:Persistent fetal vasculature may be associated with tractional retinal detachment due to tractional contraction of the fibrovascular stalk. Persistent fetal vasculature is often believed to be congenital and nonprogressive. A rhegmatogenous component is far less common and is typically identified as a postoperative complication and has not been spontaneously reported. The authors present five cases illustrating potential progressive changes and complications that may arise in nonoperated persistent fetal vasculature. METHODS:This was a retrospective case series of five patients who presented with progressive retinal detachments from persistent fetal vasculature. RESULTS:Five unique cases of persistent fetal vasculature with significant progression from time of initial presentation, four of which included development of rhegmatogenous components. CONCLUSION:Patients with persistent fetal vasculature and a seemingly stable tractional detachment should undergo evaluation with a retinal specialist for risk stratification and management because rhegmatogenous detachments may occur due to ocular growth and stretch breaks, and tractional detachments can continue to progress over time.

PURPOSE:To describe the clinical course of a case of exudative vitreoretinopathy in the setting of homozygous loss-of-function PCDH12 mutations and provide a comprehensive literature review. METHODS:Retrospective case review with associated whole exome sequencing, color fundus photography, and fluorescein angiography. RESULTS:A 14-year-old male with homozygous loss-of-function PCDH12 mutations presented with bilateral decreased vision. The right eye demonstrated extensive retinal neovascularization, temporal vessel dragging, lipid exudate, and peripheral avascular retina. The left eye had tractional bands emanating from the optic nerve, exudates, and vessel dragging, and peripheral examination revealed extensive avascular retina with neovascularization and fibrotic bands. The patient was treated with sequential laser photocoagulation bilaterally. CONCLUSIONS:PCDH12 is a gene important for vascular integrity with suggested links to Wnt/β-catenin-associated signaling pathways implicated in familial exudative vitreoretinopathy (FEVR) pathogenesis. This case describes a detailed genotype-phenotype link between homozygous PCDH12 loss-of-function mutations and FEVR, suggesting a benefit to ophthalmic referral for PCDH12-associated syndromes as well as PCDH12 testing for genetically undifferentiated FEVR patients.

PURPOSE:To describe a novel off-label use of tissue plasminogen activator (tPA) in the setting of severe endophthalmitis for improved surgical outcomes during pars plana vitrectomy. METHODS:After a limited core vitrectomy is completed, 50mcg/0.1ml tPA is administered intravitreally and allowed to take effect with a 15-minute lights-out period. A fluid-fluid exchange is then carried out to lavage the inflammatory debris and tPA from the posterior segment. RESULTS:This technique allows for significantly improved surgical visualization and complete removal of inflammatory debris in the anterior and posterior segment. CONCLUSION:Increased clearance of intraocular inflammatory debris may reduce post-infection inflammatory sequalae such as posterior synechiae and preretinal membranes and achieve better surgical outcomes.

PURPOSE:To evaluate the clinical outcomes and prognostic factors in unilateral Coats disease in the era of anti-VEGF therapy. DESIGN:Global, multicenter, retrospective case series. SUBJECTS:Six hundred fifty-six eyes of 656 subjects with Coats disease were included in this study. Exclusion criteria were Coats disease secondary to retinitis pigmentosa as well as bilateral cases. METHODS:Clinical data from patients with Coats disease were collected from 20 ophthalmic practices around the world. We compared early-stage (stage 1-2) and advanced-stage (stage 3-5) Coats disease in terms of clinical characteristics and treatment modalities. MAIN OUTCOME MEASURES:Functional outcomes include achieving visual acuity (VA) of 0.3 logarithm of the minimum angle of resolution or better and VA improvement or stability. Anatomical failure was defined as the development of phthisis, chronic retinal detachment, massive fibrosis, or the requirement for enucleation. RESULTS:Subjects with early-stage disease were significantly older, with a mean age of 17.4 ± 17.8 years, compared with 7.1 ± 7.1 years in the advanced-stage group (P < 0.001). There was a male predominance in both early and advanced stages (84.7%). Advanced disease was associated with a higher incidence of strabismus (20.2% vs. 6.7%, P < 0.001) and leukocoria (12.3% vs. 3.2%, P < 0.001). More subjects with early-stage disease received laser photocoagulation as monotherapy (44.7% vs. 21.1%, P < 0.001). Additionally, early-stage disease received more sessions of intravitreal anti-VEGF injections as adjunct therapy (4.4 ± 6.2 vs. 2.7 ± 2.1, P = 0.005). Factors associated with poorer functional outcomes included worse presenting VA, advanced disease stage, and the presence of a foveal nodule. Worse presenting VA and advanced disease stage were associated with lower likelihood of anatomical success, whereas combination therapy increased the odds of anatomical success. CONCLUSIONS:Unilateral Coats disease predominantly affects males, regardless of disease stage. Identifying a foveal nodule is crucial for visual prognosis. Laser photocoagulation remains the primary treatment. Although anti-VEGF may prevent enucleation, its role in early-stage disease requires further clarification. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Purpose: Although pivotal trials have demonstrated efficacy of anti-vascular endothelial growth factor therapy in neovascular age-related macular degeneration, there is a paucity of clinical data about the long-term (>5 years) treatment. Methods: Retrospective analysis of all patients with neovascular age-related macular degeneration who were actively treated, had received >40 anti-vascular endothelial growth factor injections, and were followed for >= 5 years. Snellen-corrected visual acuity, initial drug choice, and times elapsed between treatments were collected. Rates of endophthalmitis and outcomes of submacular hemorrhage were also evaluated. Results: A total of 88 patients (162 eyes) met the inclusion criteria: the average patient age was 86.3 years with an average follow-up period of 7.6 years. The average total number of injections per eye was 69 (18.0 SD); a total of 11,208 injections were given throughout the study period, and 6 cases (0.05%) of endophthalmitis were observed. Overall, there was a clinical and statistical difference in average Snellen-corrected visual acuity at Injections #2,#3, #4, #5, #6, #10, and #20, as compared with baseline ( P = 0.03, P < 0.01, P = 0.02, P < 0.01, P = 0.01, P = 0.01, P < 0.01, respectively). Patients in the Snellen-corrected visual acuity subgroup 20/20 to 20/40 maintained vision until injection #30. Seven eyes experienced a visually significant submacular hemorrhage. Conclusion: This neovascular age-related macular degeneration cohort received on average eight anti-vascular endothelial growth factor injections per year for approximately 8 years; eyes with good (>= 20/40) initial baseline vision maintained their visual acuity, whereas those with worse Snellen-corrected visual acuity (<= 20/50) had a robust initial improvement that diminished with time. Most patients were maintained on the same initial drug of choice and the rate of endophthalmitis was low.

Purpose: To evaluate and compare surgical outcomes for syndromes with optically empty vitreous (SOEV)-associated rhegmatogenous retinal detachments. Design: A retrospective, cross-sectional, 2-arm study of a single pediatric vitreoretinal surgeon's patients from a quaternary referral center with SOEV was performed to examine visual and anatomical outcomes of rhegmatogenous retinal detachment and laser prophylaxis. Subjects: Patients identified either through slit-lamp examination (presence of an optically empty or void space in the vitreous gel structure) or genetic testing. Fifty-six eyes of 49 patients were identified in the retinal detachment arm. Sixty eyes of 48 patients were identified in the laser prophylaxis arm. Methods: Comparison of initial retinal detachment (RD) surgical repair via pars plana vitrectomy (PPV), scleral buckle (SB), or PPV-SB with final anatomical success, best-corrected visual acuity (BCVA), and number of surgical procedures. Secondary analysis was performed looking at eyes failing their initial SB, eyes with a giant retinal tear at presentation, eyes failing RD repair within specific time intervals, and eyes where hyaloid was elevated during initial vitrectomy. An additional study arm examined the outcomes of final BCVA and the presence and timing of developing a retinal tear or RD in eyes who received laser prophylaxis. Main Outcome Measures: Visual acuity, surgical repair techniques (PPV, SB, PPV-SB), number of surgeries, anatomical retinal reattachment success. Results: Initial SB had statistically significant better final BCVA (P < 0.01) and better final anatomical success (P < 0.01). No statistical difference in the number of surgeries needed to achieve anatomical success between the initial SB versus initial PPV-SB/PPV. Hyaloidal elevation during the initial vitrectomy was associated with improved final BCVA and higher final anatomical success without the use of silicone oil (P < 0.01 and 0.04 respectively). Lastly, eyes that developed RDs after laser prophylaxis had better final BCVA than untreated eyes (P < 0.05). Conclusion: Initial SB yields better overall outcomes in SOEV presenting with rhegmatogenous retinal detachment. Stickler Type-1 patients had similar outcomes compared with other SOEV, suggesting both populations should be treated with similar approaches.

Low-dose and very low-dose intravitreal bevacizumab (IVB) have been reported to be successful in short-term treatment of type 1 retinopathy of prematurity (ROP), down to an initial dose of 0.004 mg. We now report 12-month outcomes for these infants.Masked, multicenter, dose de-escalation study.One hundred twenty prematurely born infants with type 1 ROP.A cohort of 120 infants with type 1 ROP in at least 1 eye from 2 sequential dose de-escalation studies of low-dose IVB (0.25 mg, 0.125 mg, 0.063 mg, and 0.031 mg) or very low-dose IVB (0.016 mg, 0.008 mg, 0.004 mg, and 0.002 mg) to the study eye; the fellow eye (if also type 1) received 1 dose level higher of IVB. After primary success or failure at 4 weeks, clinical management was at investigator discretion, including all additional treatment.Reactivation of severe ROP by 6 months corrected age, additional treatments, retinal and other ocular structural outcomes, and refractive error at 12 months corrected age.Sixty-two of 113 study eyes (55%) and 55 of 98 fellow eyes (56%) received additional treatment. Of the study eyes, 31 (27%) received additional ROP treatment, and 31 (27%) received prophylactic laser therapy for persistent avascular retina. No trend toward a higher risk of additional ROP treatment related to initial IVB doses was found. However, time to reactivation among study eyes was shorter in eyes that received very low-dose IVB (mean, 76.4 days) than in those that received low-dose IVB (mean, 85.7 days). At 12 months, poor retinal outcomes and anterior segment abnormalities both were uncommon (3% and 5%, respectively), optic atrophy was noted in 10%, median refraction was mildly myopic (-0.31 diopter), and strabismus was present in 29% of infants.Retinal structural outcomes were very good after low- and very low-dose IVB as initial treatment for type 1 ROP, although many eyes received additional treatment. The rate of reactivation of severe ROP was not associated with dose; however, a post hoc data-driven analysis suggested that reactivation was sooner with very low doses.

Trisomy 13 is associated with a variety of ocular findings. As more children with trisomy 13 survive beyond their first year of life, early identification and awareness of associated ocular manifestations is increasingly important. This retrospective case series of 5 patients with trisomy 13 expands on what is known about the complex ocular findings associated with the condition and describes their clinical management, with a mean follow-up of 2 years. All 5 patients had microphthalmos and colobomas of the iris, 4 had corneal opacities, and 2 had kerato-irido-lenticular dysgenesis associated with glaucoma. In addition, these patients were found to have recurrent eyelid infections, congenital glaucoma, cataracts, and persistent fetal vasculature. All 5 patients had cerebral visual impairment.

Purpose: Retinal detachment (RD) is associated with poor visual outcomes in patients with acute retinal necrosis (ARN). This research was undertaken to assess the risk factors for RD in ARN.Design: Retrospective cohort study.Subjects: Patients diagnosed with ARN at a tertiary referral center from 2010 to 2020.Methods: A chart review was performed for all clinical and surgical encounters. Univariate and multivariate logistic analyses of demographic and clinical variables associated with RD were performed. Survival analyses with Kaplan-Meier estimates were performed to compare the time to RD in herpes simplex virus (HSV)-and varicella zoster virus (VZV)-associated ARN.Main Outcome Measures: Demographic information, clinical information (including visual acuity [VA]), intraocular pressure (IOP), intraocular inflammation level, the extent of retinitis, incidence and timing of retinal detachment, date of diagnosis, and treatments performed (including intravitreal injections of antiviral medications). Results: Fifty-four eyes of 47 patients who were diagnosed with ARN were included, with equal proportions of eyes (n = 27; 50%) with VZV-ARN and HSV-ARN. Patients with VZV-ARN were, on average, older, more likely to be men, and more likely to be immunosuppressed compared with patients with HSV-ARN. The clinical characteristics, including the initial VA, initial IOP, anterior segment inflammation, clock hours, and posterior extent of retinitis, were similar between eyes with VZV-and HSV-ARN. In the univariate analysis of clinical and demographic variables associated with the development of RD, initial VA (P = 0.0083) and greater clock hours of retinitis (P = 0.009) were significantly associated with RD. These 2 variables remained significant in the multivariate logistic regression; worse VA at presentation had an odds ratio of 2.34 (95% confidence interval [CI], 1.01-5.44; P = 0.042), and greater clock hours of retinitis had an odds ratio of 1.23 (95% CI, 1.02-1.47; P = 0.025). A Kaplan-Meier survival analysis demonstrated no statistical difference in RD-free survival between HSVand VZV-ARN.Conclusions: Patients with VZV-ARN were more likely to be older, male, and immunosuppressed compared with those with HSV-ARN, although no clear difference was observed in RD by viral etiology. Poor initial VA and clock hours of retinitis were significantly associated with RD development and may be relevant for patient counseling and prognosis. Ophthalmology Retina 2022;6:478-483 2022 by the American Academy of Ophthalmology

Purpose: Long-term hydroxychloroquine use can result in irreversible maculopathy and vision loss. New screening guidelines to identify early maculopathy were issued by American Academy of Ophthalmology (AAO) in 2016; however, few studies have evaluated compliance with these updated guidelines. Methods: This cross-sectional study evaluated compliance with hydroxychloroquine maculopathy screening examinations at a large academic institution. Patients seen in the ophthalmology department who were prescribed hydroxychloroquine between 2011 and 2021 were included. This retrospective chart review included patients screened for hydroxychloroquine toxicity between 2011 and 2021. The main outcome measure was compliance with AAO screening guidelines (based on 2011 guidelines for patients screened between 2011 and 2015 and on 2016 guidelines for those screened in 2016 and later). Results: Of the 419 patients included, 239 were evaluated between 2011 and 2015 and 357 between 2016 and 2021. Only 60.7% of patients screened before 2016 met the recommended screening examination frequency, while 40.6% received adequate visual field screenings. Of patients screened after 2016, 55.3% met the recommended examination screening frequency, 46.4% received screening with macula ocular coherence tomography at the recommended interval, and 21.0% received appropriate visual field screening. One third of patients were prescribed higher than the recommended 5 mg/kg/day of hydroxychloroquine. Ten patients developed definite macular toxicity; most had concomitant risk factors for toxicity. Conclusions: Despite clear guidelines set forth by AAO in 2011 and 2016, compliance with screening was suboptimal. Hydroxychloroquine prescribers and eye care providers must collaborate to ensure patients are not overdosed and that they receive appropriate maculopathy screening.

Purpose: To report a case of severe retinal ischemia in an infant with neurofibromatosis type 1. Methods: Chart review, analysis of imaging studies, and review of literature. Results: A boy born at 37 weeks postmenstrual age with neurofibromatosis type 1 was noted to have a large plexiform neurofibroma with left-sided involvement of the cavernous sinus, internal carotid artery, orbit, and optic nerve. He was managed for left eye glaucoma with anti-hypertensive eye drops, and at 8 months of age, he was referred for retinal evaluation. Fluorescein angiography showed striking nonperfusion of the left retina with only a small area of perfused vessels in the posterior pole. A large frond of neovascularization extended anteriorly from the posterior pole. The right eye had a crescent of retinal nonperfusion in the far periphery but otherwise normal retinal vessels. Conclusion: This case demonstrates a severe form of retinal ischemia in the setting of a large neurofibroma because of neurofibromatosis type 1. We hypothesize that vascular compression from the tumor led to disruption of the neurovascular bundle with resultant severe nonperfusion, neovascularization, and retinal maldevelopment.

OBJECTIVE To describe perioperative practice patterns among retinal surgeons managing retinal detachment (RD) repair. METHODS This was a cross-sectional pilot survey of vitreoretinal surgeons in the United States (US), identified by a previously published web-based search and cross-referencing names from the American Society of Retina Specialists. Self-reported peri-operative practices and subgroups were analyzed. RESULTS Of the 298 surgical retina specialists who completed the survey, 115 (39%) were in practice for ≤ 5 years, 102 (34%) were in practice for 6 to 20 years, and 81 (27%) were in practice for > 20 years; 60%, 23%, and 16% were in private, academic, and hybrid practice, respectively. Fifty-nine percent reported operating with trainees. For ocular blocks, 59% perform retrobulbar, 21% peribulbar, and 20% subtenon's (ST). Use of ST block varied significantly by years in practice and presence of trainees (P < 0.0001, P = 0.004, respectively). Sixty percent perform primary scleral buckles (SB), 55% combined SB/pars plana vitrectomy (PPV), and 11% primary PPVs under general anesthesia. Use of general anesthesia for primary SB varied significantly by years in practice (P = 0.007). Surgeons with fewer years in practice were more likely to recommend facedown positioning for macula-off RDs (P < 0.0001). Forty-six percent of surgeons do not advise stopping blood thinners before surgery and this varied significantly by years in practice (P = 0.006). CONCLUSIONS Variation exists among US vitreoretinal surgeons in relation to anesthesia, postoperative positioning, and blood thinners restrictions. Preferences are influenced by years in practice and less by trainees and practice setting. These results serve as a basis for larger, targeted US-based surveys on perioperative care and correlation with surgical outcomes. [Ophthalmic Surg Lasers Imaging Retina 2022;53:681-690.].

BACKGROUND:Application of current retinopathy of prematurity (ROP) screening criteria results in many unnecessary examinations, because only 5%-10% of infants screened require treatment. Application of screening criteria established by the Postnatal Growth and Retinopathy of Prematurity Study could significantly reduce unnecessary examinations without sacrificing sensitivity to detect treatment-requiring ROP. We evaluated the performance of the G-ROP criteria in a population of high-risk, outborn infants.METHODS:The medical records of consecutive infants screened and/or treated for ROP at Children's Health Care of Atlanta Hospitals from May 1, 2013, to September 6, 2019, were reviewed retrospectively. The sensitivity of the G-ROP birthweight and gestational age screening criteria to detect treatment-requiring ROP was calculated.RESULTS:During the study period, 901 children underwent examinations for ROP; of these, 5 were excluded from the analysis because birth weight (BW) data was lacking. Of the 896 remaining patients, 120 patients were treated for ROP. Application of G-ROP birth weight and gestational age (GA) criteria alone resulted in a sensitivity of 99.2% to detect infants requiring treatment. Application of weight gain criteria was problematic, because many patients were transferred into our institutions after the specified intervals of 10-19, 20-29, and 30-39 days.CONCLUSIONS:G-ROP BW and GA screening criteria were highly sensitive in detecting treatment-requiring ROP. Applying weight gain criteria in referral centers can be problematic. Intake procedures at referral centers should include documentation of weight gain during 10-19, 20-29, and 30-39 days of life.

We report the case of 10-year-old girl who developed retinal neovascularization and vitreous hemorrhage 10 years after successful treatment of type 1 retinopathy of prematurity infant with intravitreal bevacizumab without laser ablation therapy.

PURPOSE: To present the reoperation rates of patients who underwent a primary noncomplex RD repair in a cohort of the American Academy of Ophthalmology IRIS Registry. DESIGN: Retrospective, nonrandomized comparative clinical study. METHODS: This was a retrospective, nonrandomized cohort study of patients who underwent a primary noncomplex RD repair with either a scleral buckle (SB) or vitrectomy with or without scleral buckle (PPV +/- SB) between 2013 and 2016. The primary outcome was the odds of reoperation within 12 months. RESULTS: Of 24,068 patients, 2,937 patients (12.2%) underwent an SB and 21,131 patients (87.8%) a PPV +/- SB. The overall reoperation rate was 12.2% for SB and 11.6% for PPV +/- SB. After multivariate adjustment for age and initial RD diagnosis, the PPV +/- SB group exhibited a lower odds of reoperation within 12 months compared with SB only (OR 0.84, 95% CI 0.75-0.96, P = .007). However, there was an age interaction. Patients <= 50 years old with PPV +/- SB exhibited a higher odds of reoperation (OR 1.46, 95% CI 1.14-1.88, P = .003) compared to SB only. Patients >50 years with PPV +/- SB had a lower odds of reoperation (OR 0.73, 95% CI 0.63-0.84, P < .0001). CONCLUSION: The odds of reoperation of PPV +/- SB compared with SB only varies depending on the patient's age. Further subset analyses are required to determine if there are clinically relevant differences with respect to RD configuration or other RD repair types (PPV only vs PPV with SB). (Am J Ophthalmol 2021;222: 69-75.

Purpose: The mainstay empiric treatments of bacterial endophthalmitis are intravitreal vancomycin and ceftazidime. In the United States, up to 10% of the general population has a reported penicillin (PCN) allergy. Despite low cross-reactivity between PCN and later-generation cephalosporins, some providers alter the intravitreal antibiotic choice for endophthalmitis because of concern for allergic reactions. We evaluated the management strategies of infectious endophthalmitis in the setting of self-reported systemic antibiotic allergies and the association with adverse reactions after standard intravitreal antibiotic administration. Design: Single-center, retrospective cohort study. Participants: All patients with endophthalmitis between 2005 and 2019 and documented PCN, PCN-analog, cephalosporin, or vancomycin allergy who received intravitreal antibiotics on the basis of International Classification of Diseases 9th and 10th Revisions, and Current Procedural Terminology codes. Methods: Retrospective chart review. Main Outcome Measures: Any allergic reaction after intravitreal injection, additional surgical interventions required for treatment, and visual function at last recorded visit. Results: Of the 65 patients included in this cohort, the most common causes of endophthalmitis were postcataract extraction surgery (n 1/4 23, 35.4%) and postintravitreal injection (n 1/4 11, 16.9%). All patients (65/65) received intravitreal vancomycin, and 81.5% (53/65) received intravitreal ceftazidime. Of the 53 patients who received intravitreal ceftazidime, 46 (86.8%) had allergies to PCNs alone, 5 (9.4%) had a cephalosporin allergy alone, and 2 (3.8%) had reported allergies to both PCN and cephalosporin antibiotics. Two patients (3.1%) with a documented vancomycin allergy received intravitreal vancomycin without complication. No patients exhibited any systemic or local allergic reactions or complications after intravitreal injection. Conclusions: There were no documented allergic reactions in this cohort of patients with systemic antibiotic allergies who were treated for infectious endophthalmitis. Our findings are consistent with previous reports of a low allergic cross-reactivity between PCN and later-generation cephalosporins. Ophthalmologists should use evidence-based practices and a careful informed consent process when choosing intravitreal antibiotics for patients with specific antibiotic allergies. In the routine patient with suspected bacterial endophthalmitis, PCN allergy may not be an absolute contraindication to intravitreal cephalosporin use. (C) 2020 by the American Academy of Ophthalmology