Incidence and management of acute endophthalmitis after intravitreal bevacizumab (Avastin) injection

Abstract

Introduction The aim of this study was to report the incidence and management of acute endophthalmitis after intravitreal injection of Avastin (bevacizumab), and visual acuity outcomes of three eyes of three patients who developed acute endophthalmitis following intravitreal injection of Avastin. Methods This clinical retrospective, non-comparative study included 3022 intravitreal injections of 1.25 mg bevacizumab consecutively performed for 1822 eyes with exudative age-related macular degeneration and other retinal diseases. Of 3022 injections, 1200 were reinjections. After clinical appearance of post-injection endophthalmitis, immediate intervention was performed, including injection of intravitreal antibiotics and early pars plana vitrectomy. Results Three eyes of three patients with acute postoperative endophthalmitis were identified in the first week following intravitreal injections of 1.25 mg bevacizumab. Among of these patients, two cases were culture-positive and one case was culture-negative. Compared with presenting visual acuities, all of three patients improved at the end of follow-up time. The overall incidence rate of post-injection culture-proven endophthalmitis was 0.066%. Discussion Acute culture-proven endophthalmitis is still a potential complication of intravitreal bevacizumab injection (approximately 0.066%) despite using maximal sterile techniques. Acute post-injection endophthalmitis following intravitreal bevacizumab occurs rapidly and can result in severe loss of vision. Prompt

Meta-Analysis of Endophthalmitis After Intravitreal Injection of Anti–vascular Endothelial Growth Factor Agents

“…The relevant information from these articles is summarized in Table 1. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Studies reporting endophthalmitis and causative organisms after intravitreal injection outside the United States were reports by Aggio et al, 21 Alkuraya et al, 22 Artunay et al, 23 and Yenerel et al, 24 and Wu et al 25 A report by Lee et al 26 was excluded because the authors convincingly tracked the occurrence of two cases of Serratia marcescens endophthalmitis to pharmacy contamination. In the VEGF Inhibition Study in Ocular Neovascularization (VISION) trial 27,28 publications, causative organisms of the 12 cases of endophthalmitis were not reported, and thus, these cases were not considered in the meta-analysis.…”

Storage stability of bevacizumab in polycarbonate and polypropylene syringes

“…It is not unreasonable to expect that intravitreal use of bevacizumab will continue in many parts of the world; especially, in resource-limited regions and for older patients whose overall health and social care costs are already high and are expected to increase. 17,18 The reported incidence of IOP spike 19,20 or endophthalmitis that may be associated with bevacizumab injections [21][22][23][24] is thought to be related to the presence of particulates or protein aggregates. 20,25 The presence of silicon oil contamination and the type of syringe used for repackaged bevacizumab has also been reported to be associated with an increase in protein aggregates or particulate count.…”

Safety of Submacular Suprachoroidal Drug Administration via a Microcatheter: Retrospective Analysis of European Treatment Results

“…Despite the tremendous strides made in the treatment of CNV associated with a variety of chorioretinal disorders, some patients remain unresponsive to widely applied therapies including intravitreal injections of vascular endothelial growth factor antagonists [2,3]. Limitations of intravitreal injections include the need for multiple injections [4] and the risk of complications such as endophthalmitis [5], retinal detachment [6] and cataract formation [7]. In addition, drug treatment of posterior segment diseases of the eye such as CNV may be hampered by poor intraocular penetration and rapid elimination of the drug from the eye [8].…”