A case of sterile endophthalmitis after repeated intravitreal bevacizumab injection.

Ophthalmology Department, Yeditepe University Eye Hospital, Istanbul, Turkey.
Journal of Ocular Pharmacology and Therapeutics (Impact Factor: 1.42). 07/2008; 24(3):362-3. DOI: 10.1089/jop.2007.0126
Source: PubMed

ABSTRACT The aim of this study was to describe a case of sterile endophthalmitis after repeated intravitreal bevacizumab injections for the treatment of choroidal neovascularization secondary to angioid streaks.
This study was done as a case report.
A 57-year-old man who received a third injection of intravitreal bevacizumab for the treatment of choroidal neovascularization owing to angioid streaks developed sterile endophthalmitis. The patient's condition improved after hourly topical steroid and antibiotic drops without a sequele.
The intravitreal injection of bevacizumab has the potential for the development of sterile endophthalmitis. The patients should be warned against this possible adverse reaction, especially after repeated injections.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Uveitis has been reported in association with a variety of topical, intraocular, periocular, and systemic medications. To establish causality of adverse events by drugs, in 1981, Naranjo and associates proposed seven criteria, which are related to the frequency and documentation of the event; circumstances of occurrence, recovery, and recurrence; and coexistence of other factors or medications. Rarely does a drug meet all seven criteria. The authors review reports of drug-associated uveitis, applying the seven criteria and examining possible mechanisms. Only systemically administered biphosphonates and, perhaps, topical metipranolol meet all seven criteria. Systemic sulfonamides, rifabutin, and topical glucocorticoids fulfill at least five criteria.
    Survey of Ophthalmology 05/1998; 42(6):557-70. DOI:10.1016/S0039-6257(97)00130-6 · 3.51 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: There is an active and controversial debate about the role of intravitreal bevacizumab versus approved drugs in the treatment of neovascular age-related macular degeneration (AMD). Because bevacizumab was available prior to the launch of ranibizumab, off-label use of the former became widespread and the cancer drug bevacizumab is the most commonly used medication in ophthalmology nowadays. This review considers every publication identified in MEDLINE using the keywords 'bevacizumab' and 'Avastin' between 1 June 2005 and 31 July 2008. The search identified 511 papers that were evaluated. In 33 studies, there was consistent and clear evidence for the efficacy of bevacizumab in neovascular AMD. However, the highest grade studies (three prospective, randomized, controlled trials) did not attain better than grade 2b level of evidence, and objective evaluation of the benefit of bevacizumab relative to representative controls was therefore not possible. Certainly, the available evidence is inferior to that obtained from the approval studies of ranibizumab and this should influence treatment selection and guidance of patients. These considerations indicate that important quality criteria need to be included in future studies to ensure more meaningful conclusions can be drawn. These include clearly defined inclusion criteria, information about the recruitment procedure (including data on withdrawals, excluded patients, concealed treatment allocation, use of intention-to-treat analyses and blinded assessment procedures). Although preclinical studies have almost exclusively found bevacizumab to be safe, the design utilized in clinical case series cannot rule out a possible increase in adverse events, which already show a high spontaneous incidence in elderly AMD patients. The superior evidence level for ranibizumab and the limited safety data for bevacizumab must be taken into consideration when evaluating the costs that a healthcare system is willing to spend. However, the superior grade of evidence for ranibizumab should not be confused with the (still missing) evidence for superior efficacy. The results of ongoing randomized, controlled, comparative trials will provide further data on the efficacy and cost effectiveness of bevacizumab and ranibizumab in the treatment of AMD. In the meantime, patients should be informed about the alternatives, the price differences and the restricted liability issue when off-label use of bevacizumab is offered.
    Drugs & Aging 02/2009; 26(4):295-320. DOI:10.2165/00002512-200926040-00002 · 2.50 Impact Factor
  • Canadian Journal of Ophthalmology 10/2009; 44(5):39-40. DOI:10.1139/i09-107 · 1.30 Impact Factor