Vitreous Inflammation Associated with Intravitreal Anti-VEGF Pharmacotherapy

Agrawal, Shivi; Joshi, Malav; Christoforidis, John B.

doi:10.1155/2013/943409

Cited by 64 publications

(64 citation statements)

References 51 publications

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“…The results of the study demonstrated that there was no significant change in aqueous flare values in either IVR- or IVA-injected patients and no significant difference from the control group. There have been previous reports of sterile intraocular inflammation after anti-VEGF injections in the literature [14]. These rates for severe inflammation are low and a large population would be needed for evaluating any difference between anti-VEGF agents.…”

Section: Discussionmentioning

confidence: 99%

“…Ranibizumab is a 48-kDa recombinant humanized monoclonal antibody fragment, while aflibercept is a 115-kDa recombinant fusion protein [13,14]. As an antibody-binding fragment, ranibizumab lacks the domain that activates compliment-mediated cytotoxicity and Fc receptors on immune cells.…”

Section: Discussionmentioning

confidence: 99%

“…As an antibody-binding fragment, ranibizumab lacks the domain that activates compliment-mediated cytotoxicity and Fc receptors on immune cells. This lack also provides shorter circulation time and faster clearance [14]. It could be expected that ranibizumab will induce a lesser inflammatory response compared to aflibercept due to its smaller protein load and lack of an Fc region.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of sterile intraocular inflammation after anti-VEGF injections ranges between 0.03 and 2.9% in the literature [14]. Although these rates for severe inflammation are low, lower grade inflammatory changes after intravitreal injections may be present in a larger number of patients.…”

Section: Introductionmentioning

confidence: 99%

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Is There Any Difference between Ranibizumab and Aflibercept Injections in Terms of Inflammation Measured with Anterior Chamber Flare Levels in Age-Related Macular Degeneration Patients: A Comparative Study

Demirel¹,

Bilici²,

Batıoğlu³

et al. 2016

Ophthalmic Res

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Purpose: To evaluate the inflammatory reaction to intravitreal aflibercept (IVA) or ranibizumab (IVR) in patients with age-related macular degeneration (AMD). Methods: A total of 60 eyes of 60 neovascular AMD patients and 30 eyes of 30 age-matched healthy people as a control group were included in this observational, prospective, comparative study. The AMD patients received 1:1 either IVA or IVR. Anterior chamber flare was measured with the Kowa FM-600 laser flare meter (Kowa Company, Ltd., Tokyo, Japan) at days 0, 1, and 30. The mean flare value and standard deviation are expressed as photon counts per millisecond. Results: There were 51 (56.7%) men and 39 (43.3%) women, with a mean age of 72.7 ± 7.5 years. Mean aqueous flare values at baseline, day 1 and day 30 were 7.08 ± 2.44, 7.23 ± 2.56, and 6.99 ± 2.29, respectively, for the IVR group, 6.87 ± 3.18, 6.86 ± 3.19, and 6.53 ± 2.79, respectively, for the IVA group, and 6.4 ± 3.29, 6.41 ± 3.06, and 6.42 ± 3.05, respectively, for the control group. There was no statistically significant difference in terms of baseline flare values for these three groups (p = 0.666). At the 1-day follow-up, a slight but not significant increase in flare was observed in the ranibizumab group. However, there was no significant change in aqueous flare values in either the ranibizumab- or the aflibercept-injected patients (p = 0.768 and p = 0.387, respectively) or between the groups (p = 0.635). No significant clinical inflammatory reactions were noted before or after intravitreal injections of either ranibizumab or aflibercept. Conclusion: No significant short-term intraocular inflammation was noted in the eyes receiving aflibercept or ranibizumab for the treatment of neovascular AMD. Although aflibercept has more immunogenic properties than ranibizumab, such as having an extra Fc portion and being a larger molecule, it is likely that its more potent anti-inflammatory effects prevent it from inducing inflammation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Is There Any Difference between Ranibizumab and Aflibercept Injections in Terms of Inflammation Measured with Anterior Chamber Flare Levels in Age-Related Macular Degeneration Patients: A Comparative Study

Demirel¹,

Bilici²,

Batıoğlu³

et al. 2016

Ophthalmic Res

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“…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%

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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Early Experience With Brolucizumab Treatment of Neovascular Age-Related Macular Degeneration

et al. 2021

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IMPORTANCEOutcome data are limited regarding early experience with brolucizumab, the most recently approved anti-vascular endothelial growth factor (VEGF) agent for the treatment of neovascular age-related macular degeneration (nAMD).OBJECTIVE To report clinical outcomes after intravitreous injection (IVI) of brolucizumab, 6 mg, for nAMD. DESIGN, SETTING, AND PARTICIPANTSThis retrospective case series conducted at 15 private or academic ophthalmological centers in the United States included all consecutive patients with eyes treated with brolucizumab by 6 retina specialists between October 17, 2019, and April 1, 2020. EXPOSURES Treatment with brolucizumab IVI, 6 mg. MAIN OUTCOMES AND MEASURES Change in mean visual acuity (VA) and optical coherence tomography parameters, including mean central subfield thickness and presence or absence of subretinal and/or intraretinal fluid. Secondary outcomes included ocular and systemic safety. RESULTS A total of 172 eyes from 152 patients (87 women [57.2%]; mean [SD] age, 80.0 [8.0] years) were included. Most eyes (166 [96.5%]) were not treatment naive, and 65.7% of these eyes (109 of 166) were switched from the prior anti-VEGF agent because of persistent fluid detected on optical coherence tomography scans. Study eyes received a mean (SD) of 1.46 (0.62) brolucizumab IVIs. The mean (SD) VA prior to starting brolucizumab was a 64.1 (15.9) Early Treatment Diabetic Retinopathy Study (ETDRS) letter score (Snellen equivalent, 20/50) and was a 63.3 (17.2) ETDRS letter score (Snellen equivalent, 20/63) at the last study evaluation (mean difference, 0.8; 95% CI, −2.7 to 4.3; P = .65). When analyzed by number of brolucizumab IVIs, the presence or absence of fluid prior to starting brolucizumab, or the presence or absence of intraocular inflammation after receiving brolucizumab, there was no difference in mean VA prior to starting brolucizumab compared with after brolucizumab IVIs or at the final study evaluation. The mean (SD) central subfield thickness in all eyes prior to starting brolucizumab was 296.7 (88.0) μm and was 269.8 (66.5) μm at the last study examination (mean difference, 26.9 μm; 95% CI, 9.0-44.7 μm; P = .003). Intraocular inflammation was reported in 14 eyes (8.1%) and was self-limited and resolved without treatment in almost half those eyes (n = 6). One previously reported eye (0.6%) had occlusive retinal vasculitis and severe loss of vision. CONCLUSIONS AND RELEVANCEIn this analysis of brolucizumab IVI for nAMD, VA remained stable, with a reduction in central subfield thickness. Intraocular inflammation events ranged from mild with spontaneous resolution to severe occlusive retinal vasculitis in 1 eye.

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Vitreous Inflammation Associated with Intravitreal Anti-VEGF Pharmacotherapy

Cited by 64 publications

References 51 publications

Is There Any Difference between Ranibizumab and Aflibercept Injections in Terms of Inflammation Measured with Anterior Chamber Flare Levels in Age-Related Macular Degeneration Patients: A Comparative Study

Is There Any Difference between Ranibizumab and Aflibercept Injections in Terms of Inflammation Measured with Anterior Chamber Flare Levels in Age-Related Macular Degeneration Patients: A Comparative Study

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

Early Experience With Brolucizumab Treatment of Neovascular Age-Related Macular Degeneration

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