Immediate Complications of Intravitreal Injections With Anti-Angiogenics After Use of a Standard Operating Protocol. A Purpose of 1114 Consecutive Cases

Abstract

Introduction: : Immediate complications of intravitreal injections with anti-VEGF after use of a standard operating protocol. Ricardo P. Casaroli-Marano; Amanda Rey; Marina Mesquida; Alejandro Saint-Jean; Anniken Burés; Laura Pelegrín; Joan Giralt; Socorro Alforja; Alfredo Adán; Manuel Navarro.Instituto Clínic de Oftalmología, Hospital Clínic de Barcelona (HCB).

Purpose: : Intraocular therapy with drugs that inhibit VEGF represents a new hope for patients with neovascular AMD. The aim of this study is to evaluate the immediate complications (up to 48 hours) of intravitreal injections following the application of a standard operating protocol (SOP).

Methods: : We carried-out a retrospective observational study of 1114 consecutive intravitreal injections with anti-VEGF for the treatment of neovascular AMD. The occurrence of immediate complications in the first 48 hours were recorded and analyzed. We used a SPO for intravitreal injections which consisted in local antibiotic regimen before and after treatment, performance in sterile environment and immediate check of vision and funduscopic state thereafter.

Results: : The non-compliance of pre-injection antibiotic regimen was observed in 0.18% (n=2) and drug allergies in 0.27% (n=3). The main complications observed were: traumatic subconjunctival hemorrhage (> 1 quadrant) (1.52%, n=17), occlusions of the central retinal artery (1.25%, n=14) and the presence of sudden amaurosis with permeable retinal arterial circulation (0.44%, n=5). It could demonstrate the association of anti-platelet aggregating and anti-coagulants drugs in 25% of patients (4/17) who presented subconjunctival hemorrhage. We were unable to correlate episodes of sudden amaurosis and arterial occlusion episodes with clinic pictures of intraocular hypertension or ocular hypotensive treatments. The incidence of traumatic subconjunctival hemorrhage was lower with the use of 30-gauge needle (0.91%, 1:110) compared with 32-gauge needles (2.95%, 1:34). Occlusions of the central retinal artery and sudden amaurosis occurred in 1.25% (1:80) for Ranibizumab (0.5mg/50µl), 9.37% (1:11) for the Sodium Pegaptanib (0.3mg/90µl) and 5.33% (1:25) for Bavacizumab (1.25mg/50µl). There was no immediate complication in 96.22% (n=1072).

Conclusions: : This study shows that the immediate complications of intravitreal injections with anti-VEGF drugs are uncommon and easily reversible with the use of a SOP.

Keywords: age-related macular degeneration • injection • vascular endothelial growth factor