Endophthalmitis Associated with Intravitreal Anti-Vascular Endothelial Growth Factor Injections

Schwartz, Stephen G.; Flynn, Harry W.

doi:10.1007/s40135-013-0033-1

Cited by 23 publications

(15 citation statements)

References 48 publications

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“…3 Recently, increasing number of cases are occurring after intravitreal injections of antivascular endothelial growth factor (VEGF) medication due to a dramatic increase in the number of injections annually. 4 Indian studies have found that the major pathogens causing acute postoperative endophthalmitis include coagulasenegative staphylococci (70%), Staphylococcus aureus (10%), and Streptococci (9%), which matches with the western data as well. Precautions and measures have to be taken to prevent acute postoperative endophthalmitis, which is a challenge to treat, and has a poor visual outcome.…”

Section: Introductionsupporting

confidence: 75%

Preoperative Conjunctival Swab Analyses for Chloramphenicol and Moxifloxacin in Normal Ocular Commensals

Jacob¹

2017

DJO

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Section: Introductionsupporting

confidence: 75%

Preoperative Conjunctival Swab Analyses for Chloramphenicol and Moxifloxacin in Normal Ocular Commensals

Jacob¹

2017

DJO

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“…17 Because the positive culture rate of vitreous tap can be quite low even in infectious cases and because these patients were treated with antibiotics, we refer to these cases as "presumed noninfectious. "…”

Section: Discussionmentioning

confidence: 99%

“…Noninfectious endophthalmitis has been widely reported both as sporadic events and as clusters; in most cases inflammation regressed with no treatment or with topical treatment. 17 Multiple case series have described clusters of presumed, noninfectious endophthalmitis in patients treated with injections from the same batch. Sato et al 7 reported that 5 of 35 patients (14.3%) injected with the same lot of bevacizumab developed severe intraocular inflammation.…”

Section: Table 1 Demographic and Clinical Data Of The Patients Affecmentioning

confidence: 99%

“…There are several hypotheses concerning the etiology, relating either to the molecule itself or to compounding. [17][18][19][20] First, according to the manufacturer's guidelines (http:// www.gene.com/download/xml/avastin.xml#s2.2), bevacizumab must be stored in the original sterile glass vials at 2°-8° C (36°-46° F) and protected from light. Diluted bevacizumab solution may be stored at 2°-8°C for up to 8 hours.…”

Section: Table 1 Demographic and Clinical Data Of The Patients Affecmentioning

confidence: 99%

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A cluster of presumed, noninfectious endophthalmitis after intravitreal injection of bevacizumab: long-term follow-up

et al. 2016

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Purpose-To report the outcome of 5 consecutive cases of presumed, noninfectious endopththalmitis following intravitreal injection of bevacizumab (IVB).Methods-Ten pre-loaded syringes of bevacizumab (1.25 mg/50 µL) furnished by a compounding pharmacy were injected intravitreally. Treatments were performed in the operating room by the same surgeon on 2 consecutive days.Results-Of 10 eyes, 5 showed moderate to severe ocular inflammation within a few days of injection. All patients were treated in the same surgical session. Vitreous tap performed in the patient presenting with the most severe grade of inflammation was negative for bacteria and fungi. At the time of the vitreous biopsy, this patient was injected with vancomycin 1 mg/100 µL in the vitreous cavity. Other eyes with moderate inflammation received topical and systemic antibiotics and topical steroid treatment. Visual acuity returned to pre-endophthalmitis or better levels in all eyes within 1 month. The other 5 patients treated with IVB from the same batch in the other surgical session did not develop inflammation.Conclusions-IVB can induce noninfectious endophthalmitis. The use of compounded syringes can explain clustering of the inflammation. We were unable to identify the reasons for the variable grade of inflammation we observed in our patients.Bevacizumab (Avastin; Roche, Basel, Switzerland) is a humanized monoclonal antibody binding vascular endothelial growth factor (VEGF) that was originally developed to treat metastatic carcinoma of the colon and rectum. Michels et al 1 used intravenous bevacizumab infusions as an off-label treatment for neovascular age-related macular degeneration (n-AMD). Its efficacy in this context led to off-label intravitreal bevacizumab (IVB) administration and eventually widespread use as a treatment for ocular diseases associated with retinal neovascularization and edema, including macular edema secondary to retinal vein occlusion (RVO), n-AMD myopic choroidal neovascularization (m-CNV), CNV secondary to angioid streaks, diabetic macular edema (DME), and neovascular glaucoma. 2 IVB can cause procedure-related complications (traumatic cataract, retinal detachment, hemovitreous, and infectious endophthalmitis) and drug-related systemic and local side effects, including noninfectious endopththalmitis, 3 which must be distinguished from infectious endopththalmitis, 4-16 because management and prognosis of these two entities differs greatly. We report a cluster of noninfectious endophthalmitis ranging in severity from mild inflammation to severe vitritis with or without retinal involvement after IVB. In our patients, we employed single-use syringes of bevacizumab from the same batch, prepared by a single compounding pharmacy.

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“…Ancak bu enjeksiyonların görme kaybına neden olabilen retina dekolmanı, endoftalmi gibi ciddi komplikasyonlara yol açtığı bildirilmiştir (20). Endoftalmi bu komplikasyonlar arasında görsel prognozu en kötü olanıdır.…”

Section: Discussionunclassified

Intravitreal injections and complications

Demir¹,

Akarsu²,

Güven³

et al. 2015

Sisli Etfal

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Amaç: Yapılan intravitreal enjeksiyonların nedenlerini, kullanılan intravitreal ilaçları ve onların komplikasyon oranlarını sunmak Gereç ve Yöntem: Beş yıllık süre diliminde intravitreal enjeksiyon yapılan hastaların kartları geriye dönük olarak incelendi. İntravitreal enjeksiyonların hangi sebeplerle yapıldığı, hangi etken maddenin verildiği, hastaların yaşı, cinsiyeti ve enjeksiyonların komplikasyonları değerlendirildi. İntravitreal enjeksiyonlar ameliyathane şartlarında topikal anestezi altında %5 povidon iyodin konjonktival alana damlatılıp serum fizyolojikle yıkandıktan sonra 27 Gauge (G) iğne ile üst temporal alanda pars planadan vitreus boşluğuna girilerek yapıldı. Bütün enjeksiyonlardan sonra 4x1 dozunda %0.3 ofloksasin damla 1 hafta boyunca kullanıldı. İntravitreal enjeksiyonlarda bevacizumab 1.25-2.5 mg, ranibizumab 0.5 mg, triamsinolon asetonid yalnız kullanıldığında 4 mg ve bevacizumab ile birlikte kullanıldığında 2 mg dozunda kullanıldı. Bulgular: Bu çalışmaya 962 hasta (514 bayan, 448 erkek) alındı. Yaş ortalaması 65±20.3 (18-89) idi. Diyabetik maküla ödemi (DMÖ) için 574 hasta, yaşa bağlı koroid neovaskularizasyonu için 143 hasta, retinal ven kök tıkanıklığı için 47 hasta, retinal ven dal tıkanıklığı için 107 hasta, proliferatif diyabetik retinopati (DR) yalnız veya eşlik eden intraoküler hemoraji için 83 hasta, santral seröz koroidopati için 5 hasta ve yetişkin viteliform dejenerasyonu için 3 hasta olmak üzere toplam 962 hasta intravitreal enjeksiyon tedavisi almıştı. Beş yıllık süre zarfında 962 hastaya 4318 intravitreal injeksiyon yapılmıştı. İntravitreal enjeksiyon'da kullanılan etken maddelerin isimleri ve kullanılma oranları şöyleydi; bevacizumab (%57), ranibizumab (%17), triamsinolon asetonid (%16) ve triamsinolon asetonid+bevacizumab (%10). Sonuçlar: En sık enjeksiyon nedeni DMÖ ve en sık kullanılan etken madde bevacizumab idi. Gelişen en ciddi komplikasyon endoftalmi olup 2 olguda gelişti. Endoftalmi oranı % 0.046 idi. Bir olguda kendiliğinden açılan vitreus içi hemoraji oluştu. Psödoendoftalmi bir olguda triamsinolon enjeksiyonu sonrasında gelişti. Retina dekolmanı izlenmedi. Anahtar kelimeler: Bevacizumab, endoftalmi, intravitreal enjeksiyon, maküla, ranibizumab, triamsinolon asetonid ABSTRACT: Intravitreal injections and complicationsObjective: To report the indications of intravitreal injections, intravitreal drugs used and their complications rate Material and Method: The charts of patients who received intravitreal injection/s for 5 years period were reviewed retrospectively. Indications for intravitreal injections, which drug was used to intravitreally, age and gender of patients, and complications of intravitreal injections were evaluated. All intravitreal injections were performed under topical anesthesia with instillation of 5% povidone iodine and irrigation with saline solution at upper temporal area through the pars plana using 27 gauge needle in the operating room. Ofloxacin 0.3% drop was used 4x1 in all cases for one week. The amount and generic name of drugs used in intravi...

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Endophthalmitis Associated with Intravitreal Anti-Vascular Endothelial Growth Factor Injections

Cited by 23 publications

References 48 publications

Preoperative Conjunctival Swab Analyses for Chloramphenicol and Moxifloxacin in Normal Ocular Commensals

Preoperative Conjunctival Swab Analyses for Chloramphenicol and Moxifloxacin in Normal Ocular Commensals

A cluster of presumed, noninfectious endophthalmitis after intravitreal injection of bevacizumab: long-term follow-up

Intravitreal injections and complications

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