VOL. 4, No. 2, July 2008

A. Ayata, et al. [2008] Med. Hypotheses Res. 1: 75‒78.

Potential Beneficial Effects of Intravitreal Bevacizumab
as an Adjuvant in Bacterial Endophthalmitis

Ali Ayata, Melih Ünal, Dilaver Erşanlı, Sinan Tatlıpınar and
Ahmet Hamdi BİLGE

Ophthalmology Department of GATA Haydarpasa Training Hospital, Istanbul, Turkey

Abstract. Bacterial endophthalmitis is one of the most serious complications of ocular
surgery and penetrating globe injury. Its management still remains a clinical challenge
despite to attendant of intravitreal powerful wide spectral antibiotic use and vitrectomy.
Irreversibly damage of the neurosensory retina and pigment epithelium is the major cause of
the poor visual prognosis in bacterial endophthalmitis. The inflammation process which is
related to increased vascular permeability and breakdown of the blood retinal barrier is the
main pathological event during bacterial endophthalmitis.  It is obvious that treatments to
inhibit the inflammatory processes which can damage the eye in endophthalmitis are
necessary. Despite the controversy, dexamethasone is frequently used as an adjunct to
antibiotics for the treatment of endophthalmitis. The role of VEGF in inflammation has
complex interactions. Increased permeability and enhanced leukocyte rolling and adhesion
provided by VEGF play important roles in inflammation and other pathological situations.
As a consequence of these data, we hypothesized that VEGF inhibitors may repair blood-
retina barrier and diminish enhanced vascular permeability and decrease neutrophil
recruitment into vitreous leading to ocular tissue destruction in bacterial endophthalmitis.
Depletion of neutrophil recruitment into the vitreous may prolong bacterial clearance and
may increase bacterial proliferation. However, restoring vascular permeability may also
prevent nutrient and protein leakage into the vitreous and cause low bacterial proliferation
rate. Simultaneous uses of intravitreal antibiotics undertake main bacterial clearance. Future
studies defining the therapeutic effect of VEGF inhibitors combined with antibiotics might
support our new hypothesis suggesting VEGF inhibitors as an alternative adjuvant treatment
option in bacterial endophthalmitis.

Correspondence: Dr. Ali Ayata, Ophthalmology Department of GATA Haydarpasa
Training Hospital, Istanbul, Turkey. Tel: 90-505-9237007. Fax: 90-216-542 2112.
E-Mail address:

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