Characterization of Sterile Intraocular Inflammatory Responses After Intravitreal Bevacizumab Injection

Abstract

In most cases of sterile intraocular inflammation after IVB, visual acuity returned to baseline, and intraocular inflammation rarely recurred with repeat IVB or intravitreal ranibizumab.

Ocular inflammation associated with antivascular endothelial growth factor treatment

“…Secondly, patients using medications known to be pro-inflammatory to the eye, such as prostaglandin analog eye drops used to treat glaucoma, may be predisposed to inflammation. Thirdly, some retinal conditions are known to cause the breakdown of the blood-retinal barrier, such as exudative AMD, possibly degrading the immune-privileged status of the vitreous [3]. Lastly, immune responses have been documented in the serum of a small minority of patients receiving intravitreal medications, an antiidiotypic reaction against the anti-VEGF antibody [4].…”

“…Avastin is a humanized antibody, but its production via a Chinese hamster ovary (CHO) cell line could theoretically introduce immunogenic nonhuman glycosylation [3].…”

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

“…The putative mechanisms that elicit inflammation can be broadly classified as patient specific, delivery specific, and medication specific. Patient-specific factors include a history of uveitis, use of proinflammatory medications (prostaglandin analogs), and disease-induced impairment of the blood-retina barrier [26]. Delivery-specific factors, which include compounding and syringe contamination and temperature fluctuation during shipping or storage, have been implicated in increased immunogenicity of anti-VEGF agents because of protein degradation [27,28].…”

“…Delivery-specific factors, which include compounding and syringe contamination and temperature fluctuation during shipping or storage, have been implicated in increased immunogenicity of anti-VEGF agents because of protein degradation [27,28]. Medication-specific factors include formulation of the drug (lyophilized vs. solubilized) [29,30], impurities such as endotoxin [31], nonhuman protein sequences and glycosylation [26], and counterfeit drugs [32]. …”

Transvitreal Fibrinoid Pseudoendophthalmitis After Diabetic Vitrectomy

“…Pseudoendophthalmitis (sterile or noninfectious endophthalmitis) has been described after intravitreal injection of bevacizumab (Avastin; Genentech), ranibizumab (Lucentis; Genentech, South San Francisco, CA, USA), and triamcinolone. [3][4][5][6][7][8] Toxic anterior segment syndrome has also been described after anterior segment surgery. Toxic anterior segment syndrome is a well-described phenomenon of sterile anterior segment inflammation that develops immediately after anterior segment surgery, generally within 12 hours to 48 hours.…”