Noninfectious Vitritis After Intravitreal Injection of Anti-Vegf Agents

Williams, Patrick D.; Chong, Deborah Y.; Fuller, Timothy S.; Callanan, David

doi:10.1097/iae.0000000000000801

Cited by 53 publications

(33 citation statements)

References 16 publications

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“…Sterile endophthalmitis is a well-described phenomenon and is even thought to be more common with intravitreal bevacizumab over other intravitreal anti-VEGF agents. 16 However, most would agree if there is any suspicion of infection in a case of "sterile" endophthalmitis, then infectious endophthalmitis treatment should be initiated, as the visual prognosis without treatment is grim at best. After the diagnosis of endophthalmitis was made, patients received treatment on average less than 4 hours after admission to hospital, with a range of 15 minutes to 11 hours.…”

Section: Greenlane Clinical Centre Outpatient Intravitreal Injection mentioning

confidence: 99%

The Auckland Endophthalmitis Study

Cunningham

Michael

Welch

et al. 2017

Journal of VitreoRetinal Diseases

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To report on the incidence and management of endophthalmitis following intravitreal bevacizumab in Auckland, New Zealand. Method: A survey of facilities in Auckland performing intravitreal bevacizumab between January 2007 and December 2014 was undertaken. The clinical notes of patients presenting with bevacizumab-related endophthalmitis were analyzed. Results: During the study period, 39 657 intravitreal bevacizumab injections were performed, with 21 patients undergoing treatment for bevacizumab-related endophthalmitis. The incidence of endophthalmitis was 0.053% (1 per 1888 injections). Most patients (76%) were treated within 4 hours from admission to hospital. Fifteen patients received vitreous tap and inject as primary treatment. From 2013 onward, there was a trend toward vitrectomy surgery as the primary intervention, with 72% of cases receiving vitrectomy as first-line treatment. Those who underwent vitrectomy were more likely to return a culture-positive result (P ¼ .030). After treatment, the majority of patients displayed an improvement in visual acuity (67%). Conclusion: Endophthalmitis is a rare complication of intravitreal bevacizumab treatment, with an incidence of 1 per 1888 injections in our region. There has been a shift favoring primary vitrectomy surgery in the treatment of endophthalmitis, with those undergoing vitrectomy more likely to return a positive culture result.

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Section: Greenlane Clinical Centre Outpatient Intravitreal Injection mentioning

confidence: 99%

The Auckland Endophthalmitis Study

Cunningham

Michael

Welch

et al. 2017

Journal of VitreoRetinal Diseases

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“…Noninfectious in ammation was reported after anti-VEGF injections 37 . Although the incidence was very low, most anti-VEGF agents have caused in ammation after intravitreal injections [38][39][40] .…”

Section: Discussionmentioning

confidence: 99%

Changes in complement activation products after anti-VEGF injection for choroidal neovascularization in age-related macular degeneration and pachychoroid disease

Tanaka

Oguchi

Oomori

et al. 2020

Preprint

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We evaluated changes in the complement system resulting from anti-vascular endothelial growth factor (VEGF) in eyes with age-related choroidal neovascularization (CNV) including neovascular age-related macular degeneration, pachychoroid neovasculopathy, and polypoidal choroidal neovasculopathy. We measured the concentrations of the complement activation products (C3a, C4a), VEGF, and monocyte chemotactic protein-1 in the aqueous humor during intravitreal anti-VEGF injections for CNV. The VEGF level decreased significantly (P < 0.001), while the C3a and C4a levels increased significantly (P < 0.001 for both comparisons) 1 month after two monthly anti-VEGF injections. The VEGF level was correlated with the C3a (R = 0.328, P = 0.007) and C4a (R = -0.237, P = 0.055) levels at baseline, but the correlation between the VEGF and C3a levels (R = -0.148, P = 0.242) changed significantly (P = 0.028 by analysis of covariance) after anti-VEGF treatment. The C3a increase after anti-VEGF therapy did not change the visual outcomes in eyes with CNV for 1 year. Dysregulation of the complement system can be induced by excessive reduction of intraocular VEGF after anti-VEGF therapy.

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“…Data from a retrospective case series of injections given from 2006 to 2013 indicate the rate of noninfectious vitritis in nearly 100,000 intravitreal injections ranged from 0.02% to 0.16% for the various anti-VEGF agents. (27) For culture positive endophthalmitis in a case series of nearly 500,000 intravitreal injections in 5 retina clinics, the rates ranged from 0.035% to 0.039% for all the anti-VEGF and steroidal formulations administered. (28) Another center found that intravitreal injections of steroid resulted in 6.9 fold increased rate of endophthalmitis when compared with intravitreal injections of anti-VEGF therapies (0.13% vs.…”

Section: Discussionmentioning

confidence: 99%