Severe Intraocular Inflammation after Intravitreal Injection of Bevacizumab

Sato, Tatsuhiko; Emi, Kazuyuki; Ikeda, Toshihide; Bando, Hideaki; Satō, Shigeru; Morita, Shinichi; Oyagi, Tomohito; Sawada, Kosaku

doi:10.1016/j.ophtha.2009.07.041

Cited by 68 publications

(59 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…16 His clinical course was stable with the combination treatment of intravitreal bevacizumab and dexamethasone, and appears to remain stable so far on intravitreal ranibizumab alone. Early in his course, treatment with intravitreal bevacizumab repeatedly demonstrated efficacy in improving his vision and OCT findings, but he did subsequently experience a gradual decline in vision due to scarring, atrophy, and cataract progression.…”

mentioning

confidence: 84%

Intravitreal Anti-Vascular Endothelial Growth Factor Therapy for Choroidal Neovascularization Due to Sorsby Macular Dystrophy

Kapoor

Bakri

2013

Journal of Ocular Pharmacology and Therapeutics

View full text Add to dashboard Cite

Purpose: To report the first case of intravitreal bevacizumab and ranibizumab to treat choroidal neovascularization secondary to Sorsby macular dystrophy. Case: A 57-year-old male with metamorphopsia, color vision deficits, and ocular family history of Sorsby macular dystrophy was found to have a choroidal neovascular membrane (CNVM) in his left eye. He was initially treated with intravitreal bevacizumab and had visual acuity improvement and resolution of the subretinal fluid on OCT. After 8 injections, he developed presumed mild inflammation secondary to intravitreal bevacizumab and was switched to combination intravitreal bevacizumab/dexamethasone in his left eye, which consistently demonstrated efficacy in stabilizing his vision and the CNVM without producing intraocular inflammation. The right eye later developed the CNVM and he was started on intravitreal bevacizumab in this eye as well. After 8 injections in the right eye, he experienced a similar inflammatory reaction following intravitreal bevacizumab injections and was switched to combination intravitreal bevacizumab/dexamethasone in the right eye as well. Subsequently, he was switched to intravitreal ranibizumab in the left eye alone, which continued to stabilize his vision and OCT and did not cause an inflammatory reaction as he previously experienced with bevacizumab. After 5 ranibizumab injections, he experienced no inflammatory response that he appeared to have with bevacizumab, but chose to switch back to combination intravitreal bevacizumab and dexamethasone due to financial reasons. Initially, in his clinical course, he experienced consistent visual acuity improvements with intravitreal antivascular endothelial growth factor therapy and continues to enjoy functional vision nearly 7 years after his initial symptoms. Conclusions: Intravitreal bevacizumab and ranibizumab demonstrated efficacy in this case in the treatment of CNVM associated with Sorsby macular dystrophy.

show abstract

mentioning

confidence: 84%

Intravitreal Anti-Vascular Endothelial Growth Factor Therapy for Choroidal Neovascularization Due to Sorsby Macular Dystrophy

Kapoor

Bakri

2013

Journal of Ocular Pharmacology and Therapeutics

View full text Add to dashboard Cite

show abstract

“…In addition, patients exhibit a marked anterior chamber reaction without hypopyon. Large cellular aggregates of pseudogranulomatous aspect have also been observed in patients with a bevacizumab-induced non-infectious reaction in the absence of positive microbiological findings (14). No apparent benefits of systemic treatment with antibiotics have been observed in these patients; however, systemic or topical cortisone treatment have been demonstrated to be more effective (14).…”

Section: Discussionmentioning

confidence: 99%

Early clinical characteristics of bacterial endophthalmitis in retinopathy of prematurity after intravitreal bevacizumab injection: A case report

Wang

Xiang

2017

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

Abstract. Intravitreal bevacizumab injection (IVB) is emerging as a safe and effective therapy for retinopathy of prematurity (ROP); however, follow-up investigations after IVB have indicated that endophthalmitis, a rare and devastating complication, may develop. The present study reports a case of an infant with ROP who developed endophthalmitis after IVB infection. The infant was administered with an intravitreal injection of broad-spectrum antibiotics to treat the endophthalmitis. A favorable anatomic outcome was achieved after follow-up. From this case, it was discovered that the early clinical characteristics of endophthalmitis infection secondary to IVB in premature infants include: i) The clinical symptoms of endophthalmitis infection appearing as early as 3-5 days after IVB; ii) a white membranous plaque on the retina surface with an obscure circular boundary; iii) a plaque that enlarges to a gray flocculent mass and intrudes the vitreous body, where the hazing surrounds the lesion; and iv) conjunctival hyperemia and cornea edema in the anterior segment of the affected eye. This case also indicated that timely retinal screening with RetCam or a binocular ophthalmoscope 3-5 days after IVB may be effective for detecting early stage endophthalmitis in infants who are unable to complain of a loss of visual acuity. From the present case report, it is advisable that the same type of screening be performed 3-5 days after other types of eye surgery, such as cataract extraction surgery, to detect early stage endophthalmitis. Furthermore, the present case also revealed that an early intravitreal injection of broad-spectrum antibiotics may be an effective treatment for premature infants with bacterial endophthalmitis.

show abstract

“…[7][8][9][10][11] Inflammation was found in 4 other patients, treated in the same surgical session but not in the other 5 patients treated with IVB from the same batch not the other 10 patients treated with ranibizumab in the same operative sessions.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

View full text Add to dashboard Cite

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.

show abstract

Severe Intraocular Inflammation after Intravitreal Injection of Bevacizumab

Cited by 68 publications

References 23 publications

Intravitreal Anti-Vascular Endothelial Growth Factor Therapy for Choroidal Neovascularization Due to Sorsby Macular Dystrophy

Intravitreal Anti-Vascular Endothelial Growth Factor Therapy for Choroidal Neovascularization Due to Sorsby Macular Dystrophy

Early clinical characteristics of bacterial endophthalmitis in retinopathy of prematurity after intravitreal bevacizumab injection: A case report

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

Contact Info

Product

Resources

About