Sympathetic Ophthalmia Following Vitrectomy for Endophthalmitis After Intravitreal Bevacizumab

Purpose: To describe a case of sympathetic ophthalmia following vitrectomy for endophthalmitis after an intravitreal injection of bevacizumab. Design: Retrospective case report. Methods: An 84-year-old male developed sympathetic ophthalmia 4 months after vitrectomy for endophthalmitis following an intravitreal injection. The inciting blind eye was enucleated. Results: Histopathology demonstrated sympathetic ophthalmia and phacoanaphylactic endophthalmitis. Visual acuity improved from 20/200 to 20/30 in the sympathizing eye with a combination of oral prednisone and azathioprine. Conclusions: Sympathetic ophthalmia can develop following exogenous endophthalmitis but has a good visual prognosis with appropriate treatment.     

Complications of Intravitreal Injections in Patients with Diabetes

Abstract

Intravitreal injections for the treatment of retinal disorders and intraocular infection have become a common ophthalmic procedure, and injections of anti-vascular endothelial growth factor agents or steroids are frequently performed for the treatment of diabetic macular edema or other diabetic vascular pathology. Diabetic patients may be at higher risk of adverse events than non-diabetic individuals given frequent systemic co-morbidities, such as cardiovascular and renal disease, susceptibility to infection, and unique ocular pathology that includes fibrovascular proliferation. Fortunately, many associated complications, including endophthalmitis, are related to the injection procedure and can therefore be circumvented by careful attention to injection techniques. This review highlights the safety profile of intravitreal injections in patients with diabetes. Although diabetic patients may theoretically be at higher risk than non-diabetic patients for complications, a comprehensive review of the literature does not demonstrate substantial increased risk of intravitreal injections in patients with diabetes.     

Incidence of Endophthalmitis after Intravitreal Injections: Risk Factors,Microbiology Profile,and Clinical Outcomes

Purpose: To report the incidence and characteristics of endophthalmitis after intravitreal injections (IVI) of antivascular endothelial growth factor agents and triamcinolone acetonide.

Methods: Patients’ medical records were retrospectively reviewed from January 2009 to June 2016, and the incidence, risk factors, clinical and microbiological characteristics of post-IVI endophthalmitis were evaluated.

Results: The total number of intravitreal injections given, which included ranibizumab, bevacizumab, and triamcinolone acetonide, was 20,566, of which 27 cases developed endophthalmitis, giving an overall incidence of 0.131%. Significant reduction (p < 0.003) in incidence of endophthalmitis was observed in patients who received prefilled compounded bevacizumab injections (0.050%) compared to multiple bevacizumab injections from a single vial (0.235%). In the triamcinolone acetonide group, the incidence was 0.26%. Staphylococcus species were isolated from 18 cases (67%), and all strains were sensitive to vancomycin.

Conclusions: Adherence to strict aseptic protocols and use of prefilled compounded bevacizumab injections reduces the rate of post-IVI endophthalmitis.     

玻璃体腔内注射Bevacizumab治疗视网膜新生血管性眼压改变

目的 初步探讨玻璃体腔内注射Bevacizumab治疗视网膜新生血管性疾病术后早期眼压变化.方法 对13例(18眼)视网膜新生血管性疾病,其中年龄相关性黄斑变性(10例,12眼)、糖尿病视网膜病变(3例,6眼),所有患者分别在第0周,6周,12周行玻璃体腔内注射Bevacizumab 1.25mg.在注射前后5min,30min,1h,2h进行眼压检查.结果 以0周注射为例,5min,30min,1h,2h内眼压分别为(18.7±5.4)mmHg、(18.1±5.3)mmHg、(17.3±5.4)mmHg,与注射前平均眼压(14.6±4.1)mmHg相比差异有统计学意义(t值分别为2.81、3.45、2.63,P值均<0.05).而随访的2h平均眼压降为(15.6±5.8)mmHg,与注射前相比差异无统计学意义(t=0.15,P>0.5).在总共48次注射中,注射后眼压监测5min时IOP值高于正常眼压值(IOP>21mmHg)的百分率为41.7%,30min时高于正常眼压值的百分率为22.9%,而在1h内85.4%,2h内91.7%的眼压测量值恢复正常.结论 玻璃体腔内注射Bevacizumab治疗视网膜新生血管性疾病早期眼压(5min)呈现短暂升高后下降,术后2h可作为门诊玻璃体腔内注射Bevacizumab早期眼压监测时间点.     

Our Experience After 1765 Intravitreal Injections of Bevacizumab: The Importance of Being Part of a Developing Story

This retrospective report describes our 20 months'experience using intravitreal injections of bevacizumab for the treatment of several retinal diseases. We describe our experience after 1765 intravitreal injections of bevacizumab in the treatment of different proliferative retinopathies – retinopathy of prematurity, choroidal neovascularization, diabetic retinopathy, among others. We believe that the findings reported in this study move us closer to a better treatment for different pathologies. However, further studies need to be performed in order to determine the safety and long-term efficacy of intravitreal bevacizumab either as first line therapy, after failure of conventional therapy, or in combination with conventional therapy.