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John M. Roberts, Jr., Brian Song, Norbert Becker, Richard Ahuja; Characteristics of Non-Infectious Uveitis Associated with Intravitreal Injection of Bevacizumab (Avastin). Invest. Ophthalmol. Vis. Sci. 2012;53(14):5504.
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To report the characteristics associated with non-infectious uveitis following intravitreal injection of bevacizumab.
We conducted a retrospective case series of patients presenting with a non-infectious uveitis following intravitreal injection of bevacizumab at a community practice from June 2009 to March 2011. Indications for treatment with intravitreal injection with bevacizumab included exudative macular degeneration in five cases and diffuse diabetic macular edema in one case. Pre-injection topical anesthetic, pre- and post-injection use of topical antibiotic, and sterile preparation were the same for all patients. All patients were given gatifloxacin drops post-injection for 3 days QID. The lot number of each injection obtained from pharmacy was recorded prior to injection.
The total number of injections performed in the practice from January 2009 to June 2011 was 1,953. There were a total of 6 patients included in the study. The mean age of patients was 74.7 years (range 54-87 years). Presenting symptoms included pain, photophobia, tearing, and injection. All patients presented with an inflammation of the anterior chamber with varying degrees of severity (range trace cell - 3+ cells / no flare - 2+flare). There was no inflammation in the vitreous or hypopyon in any of the 6 patients. The mean time from injection to presentation was 8.5 days (range 0-35 days). The mean duration of symptoms to presentation was 1.2 days (range 0-3 days). Five of six patients had a previous intravitreal injection of bevacizumab with a mean number of 6.3 injections (range 0-14). Treatment for non-infectious uveitis included only topical corticosteroid and cycloplegic agents. Mean time for resolution of inflammation was 4.7 weeks (range 1-10 weeks). Mean time for discontinuation of treatment was 7.2 weeks (range 4-14). All six patients had resolution of symptoms with topical medications, but two patients had a re-occurrence that resolved with a second course of topical therapy. Visual acuity remained unchanged in 5 patients and one patient lost one line of vision. The lot numbers for the injections was the same only for two cases.
Intravitreal bevacizumab use has become more prevalent with expanding indications in recent years. The most vision threatening complication of an intravitreal injection is infectious endophthalmitis. The signs and symptoms for non-infectious uveitis can mimic those characteristics of infectious endophthalmitis. This study illustrates that non-infectious uveitis can occur after intravitreal bevacizumab injection, and distinguishing between it and true endophthalmitis is important in order to avoid unnecessary invasive treatment.
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