Posterior vitreous detachment following intravitreal drug injection

Abstract

BackgroundTo evaluate the incidence of posterior vitreous detachment (PVD) induced by intravitreal injection of different intravitreal drugs.MethodsThis prospective observational study included 61 patients (61 eyes) with different underlying retinal diseases: exudative age-related macular degeneration (n = 47), cystoid macular edema (CME) after retinal vein occlusion (n = 8), and CME of other origin (n = 6). Bevazicumab (1.25 mg) was injected into 25 eyes, ranibizumab (0.5 mg) into 27 eyes, triamcinolone (4 mg) into six eyes, and a combination of bevacizumab and triamcinolone into three eyes. Patients with initial PVD were excluded. Patients were followed for at least 4–6 weeks after their last injection by Fourier-domain OCT, fundus biomicroscopy and ultrasound B-examination.ResultsOverall, 15 of 61 eyes developed a PVD after intravitreal injection (n = 6 after ranibizumab, n = 7 after bevacizumab and n = 2 after triamcinolon) within a mean follow-up period of 11.1 weeks. PVD occurred in three eyes after the first injection, in three eyes after the second, and in seven eyes after the third injection. Incidence of PVD correlated with increasing age.ConclusionIntravitreal injection of commonly-used drugs seems to induce posterior vitreous detachment, which may thus influence the outcome of the underlying disease.

Acute Hemorrhagic Retinopathy following Intravitreal Melphalan Injection for Retinoblastoma: A Report of Two Cases and Technical Modifications to Enhance the Prevention of Retinal Toxicity

“…Previous reports have shown that routine intravitreal injections in adults can induce posterior vitreous detachment in up to 25% of patients [10]. Moreover, endophytic tumors with vitreous seeding cause apical disruption of the internal limiting membrane/hyaloid complex, contributing to the change of the vitreoretinal interface surrounding the tumor [4].…”

Influence of the Vitreoretinal Interface on the Treatment with Anti-VEGF for Exudative Age-Related Macular Degeneration

“…It is still unclear whether the injection procedure can influence the occurrence of PVD by some pharmacological or mechanical effect. A higher figure of 24% reported by other authors [22] should be interpreted with caution, as it included a heterogeneous group of different underlying etiologies that may lead to PVD through different mechanisms other than those related to the intravitreal injection procedure.…”

Posterior Vitreous Detachment and the Associated Risk of Retinal Toxicity with Intravitreal Melphalan Treatment for Retinoblastoma

“…Intravitreal injections have been shown to induce a PVD in adult patients [24]. A more salient question, however, is whether the presence of a PVD is associated with the development of severe, hemorrhagic toxicity as has been previously hypothesized [14].…”