Characteristics of severe intraocular inflammation following intravitreal injection of bevacizumab (Avastin)

Georgopoulos, Michael; Polak, Kaija; Prager, Franz; Prünte, Christian; Schmidt–Erfurth, U.

doi:10.1136/bjo.2008.138479

Cited by 117 publications

(79 citation statements)

References 21 publications

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“…The clinical features of bevacizumab uveitis: gathered from previous studies and our patient-are as follows: [2][3][4][5][6][7] • Presentation on the first or second day after injection • Absence of pain Unlike in the reported series, our patient showed nongranulomatous inflammation that did not respond to intense topical steroid or intravitreal dexamethasone, necessitating vitrectomy. 2 He also showed a hypopyon that could be aspirated on anterior chamber tap. Our patient also underwent vitrectomy and the transient improvement was possibly due to the intravitreal dexamethasone administered along with the intravitreal antibiotics at the conclusion of surgery.…”

Section: Discussionmentioning

confidence: 62%

“…This explains why some patients in a prior report needed steroid therapy for up to two months. 2 Studies having shown the presence of bevacizumab in the vitreous for up to three months and as in our patient, prolonged systemic steroid may be necessary. 8,9 Alternatively, systemic steroids can be substituted with long acting intravitreal or periocular steroids.…”

Section: Discussionmentioning

confidence: 99%

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Vitrectomy does not Cure Bevacizumab Induced Uveitis

Shanmugam¹,

Rajesh²,

Kumar³

2011

WJORV

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Non-infectious inflammation associated with intravitreal antivascular endothelial growth factor injections has been reported recently. Failure to recognize this sterile inflammation can result in unnecessary treatment for endophthalmitis.We describe a case of acute noninfective intraocular inflammation following the third intravitreal injection of bevacizumab for nonischemic central retinal vein occlusion-associated cystoid macular edema in a 74-year-old man who responded temporarily to repeated intravitreal antibiotics and vitrectomy. Prolonged use of systemic steroid (oral prednisolone monotherapy) resulted in resolution of the uveitis. No organisms could be demonstrated even on repeated aqueous and vitreous taps.Bevacizumab-induced uveitis is a rare event and its pathogenesis remains unclear. With the increasing use of bevacizumab, it is important to be aware of its potential to be associated with intraocular inflammation and to differentiate it from infective endophthalmitis.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Vitrectomy does not Cure Bevacizumab Induced Uveitis

Shanmugam¹,

Rajesh²,

Kumar³

2011

WJORV

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“…A larger protein load, a result of the additional Fc fragment, might also be a cause of clusters of sterile endophthalmitis reported in Canada [18] and worldwide [19]. Gower et al [12] also reported an 80% higher risk of endophthalmitis with Avastin compared to Lucentis (HR, 1.8%; 99% CI, 1.2-2.8).…”

Section: Potential Impact Of Differences In the Molecular Structurementioning

confidence: 83%

Cardiac Issues of Noncardiac Drugs: The Rising Story of Avastin in Age-Related Macular Degeneration

Cruess¹,

Giacomantonio²

2013

Ophthalmologica

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Emerging safety data, accompanied with recent demographic trends, point to the need for an in-depth review and consideration of potential consequences that might arise from continuing use of bevacizumab (Avastin®) to treat elderly patients presenting with wet age-related macular degeneration (AMD). Although it is expected that lower doses of Avastin used for intravitreal administration and an intact blood-retina barrier would reduce the systemic exposure of the drug, both animal and human studies suggest that this may not be the case. In addition, emerging real-world and clinical trial data continue to point toward compromises in both cardio- and cerebrovascular safety with Avastin. Thus, clinicians are urged to adopt the highest possible standard of care in the treatment of an already fragile AMD population. Furthermore, postmarketing surveillance and pharmacovigilance with intravitreal anti-VEGF inhibitors should remain a priority.

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“…Mozayan and Farah [12] reported five cases of acute anterior uveitis presenting with severe pain and photophobia occurring within 2– 24 h after the injection. Georgopoulos et al [13] reported eight cases of uveitis presenting within 2 days after the injection with anterior uveitis, none with hypopyon and five with retinal infiltrates. The largest series to date was by Williams et al [14], who retrospectively reviewed 100,654 intravitreal injections between 2006 and 2013.…”

Section: Discussionmentioning

confidence: 99%

Noninfectious Inflammatory Response following Intravitreal Bevacizumab Injections: Description of a Cluster of Cases in Two Centers and a Review of the Literature

et al. 2018

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Purpose: To report a cluster of high incidence of noninfectious inflammatory reaction shortly after bevacizumab injection. Methods: Data were collected from medical records of consecutive patients who underwent bevacizumab injections and presented with acute uveitis within 1–4 days. Results: All 7 patients were injected intravitreally with bevacizumab from different batches and presented with visual deterioration. One patient with anterior uveitis complained of pain. None had hypopyon. Three patients with vitritis underwent a vitreous tap with an intravitreal injection of vancomycin and ceftazidime for possible infectious endophthalmitis. All patients received intensive topical antibiotic drops and steroids, and the intraocular inflammation resolved completely within 1 month. Five patients continued to receive bevacizumab injections without recurrent episodes. Conclusions: Our series demonstrates an incidence of noninfectious inflammatory reaction shortly after bevacizumab injection that is higher than that reported in the literature. The cause is more likely the preparation process in the same compounding pharmacy.

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Characteristics of severe intraocular inflammation following intravitreal injection of bevacizumab (Avastin)

Cited by 117 publications

References 21 publications

Vitrectomy does not Cure Bevacizumab Induced Uveitis

Vitrectomy does not Cure Bevacizumab Induced Uveitis

Cardiac Issues of Noncardiac Drugs: The Rising Story of Avastin in Age-Related Macular Degeneration

Noninfectious Inflammatory Response following Intravitreal Bevacizumab Injections: Description of a Cluster of Cases in Two Centers and a Review of the Literature

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