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: 1.47). 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.

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    • "Sterile intraocular inflammation has been described in patients with a severe inflammatory reaction in the anterior segment of the eye. Ocular pain and hypopyon were present in some of these patients, whereas vitreous inflammation was mild to moderate [46–49]. "
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    ABSTRACT: Sterile endophthalmitis appears as an infrequent complication of intravitreal injections and seems to develop mainly in the context of the off-label use of drugs that have not been conceived for intravitreous administration. The aetiology of sterile endophthalmitis, independently of the administered drug, remains uncertain and a multifactorial origin cannot be discarded. Sterile inflammation secondary both to intravitreal triamcinolone acetonide and to intravitreal bevacizumab share many characteristics such as the acute and painless vision loss present in the big majority of the cases. Dense vitreous opacity is a common factor, while anterior segment inflammation appears to be mild to moderate. In eyes with sterile endophthalmitis, visual acuity improves progressively as the intraocular inflammation reduces without any specific treatment. If by any chance the ophthalmologist is not convinced by the sterile origin of the inflammation, this complication must be treated as an acute endophthalmitis because of the devastating visual prognosis of this intraocular infection in the absence of therapy.
    Mediators of Inflammation 08/2012; 2012(2):928123. DOI:10.1155/2012/928123 · 3.24 Impact Factor
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    • "Intravitreal injection is a currently accepted therapy for many posterior segment ocular disorders. However, when repeated injections are required, there is a high risk of complications such as endophthalmitis [7], as well as repetitive pain, apprehension and distress associated with inserting needles into eyes. Moreover, the intravitreal half-life of 1.25mg injected bevacizumab is approximately only 3 days [8]. "
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    The Open Ophthalmology Journal 06/2012; 6:54-8. DOI:10.2174/1874364101206010054
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    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.
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