Sterile Endophthalmitis/Uveitis Following Multiple Intravitreal Bevacizumab (Avastin) Injections for Wet Age-Related Macular Degeneration

Abstract

Purpose: : Three centers report 13 patients presenting with sterile endophthalmitis, vitritis, and/or iritis after multiple bevacizumab injections, with recurrence of inflammation when re-challenged with bevacizumab or ranibizumab

Methods: : Retrospective Series

Results: : Thirteen patients presented with acute uveitis between March and November 2007 in Ontario, Canada. All were treated with intravitreal bevacizumab 1.25-1.75mg for wet macular degeneration in the prior 1-8 days (average 2.5 days). Mean number of injections received was 6.0 (range 3-9) over a mean period of 10.3 months (range 3-18 mo). No patient had a history of or risk factors for uveitis. There was no change in technique or preparation.Ten patients (77%) complained of vision loss, 11 patients (85%) complained of pain or discomfort, and one (8%) was asymptomatic. Mean logmar visual acuity prior to presentation was 20/177 (range 20/50-CF) and on presentation declined to 20/679, (range 20/200-CF). All patients had anterior chamber cellular reaction, 5 of which (38%) also had hypopyon, and 9 of which also (69%) had vitritis. Eleven patients (85%) had conjunctival injection. Five patients (38%) had diffuse corneal edema.Five patients (38%) with severe uveitis underwent aqueous and vitreous tap with injection of antibiotics and one also underwent vitrectomy. All cultures were negative. All patients received topical steroids. Six patients were subsequently re-injected with one or more bevacizumab, and two were re-injected with ranibizumab. All 7 patients who were examined following their re-injection (including one with ranibizumab) developed recurrence of iritis +/- vitritis. Mean last visual acuity was 20/183 (range 20/40-CF), not statistically different from the vision prior to inflammatory reaction. Each syringe of bevacizumab used was derived from a different batch from the compounding pharmacy.

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