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Acute sterile endophthalmitis following intravitreal bevacizumab: case series
BACKGROUND: Since the ophthalmological community adopted the use of intravitreal bevacizumab as an accepted off-label treatment for neovascular diseases, the amount of knowledge regarding its effects and properties has been increasing continually. In the last few years, there have been an increasing...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Dove Medical Press
2014
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164286/ https://www.ncbi.nlm.nih.gov/pubmed/25228797 http://dx.doi.org/10.2147/OPTH.S66230 |
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author | Orozco-Hernández, Axel Ortega-Larrocea, Ximena Sánchez-Bermúdez, Gustavo García-Aguirre, Gerardo Cantón, Virgilio Morales Velez-Montoya, Raul |
author_facet | Orozco-Hernández, Axel Ortega-Larrocea, Ximena Sánchez-Bermúdez, Gustavo García-Aguirre, Gerardo Cantón, Virgilio Morales Velez-Montoya, Raul |
author_sort | Orozco-Hernández, Axel |
collection | PubMed |
description | BACKGROUND: Since the ophthalmological community adopted the use of intravitreal bevacizumab as an accepted off-label treatment for neovascular diseases, the amount of knowledge regarding its effects and properties has been increasing continually. In the last few years, there have been an increasing number of reports about sterile intraocular inflammation and intraocular pressure elevations after intravitreal bevacizumab. In the following case series, we describe the clinical presentation and outcomes of ten consecutive cases of patients developing mild-to-severe sterile intraocular inflammation after intravitreal bevacizumab and their management. METHODS: This report presents a retrospective case series. We reviewed the medical records of ten consecutive patients from a group of 46, in whom repackaged bevacizumab in individual aliquots from two vials from the same batch were used. All surgical procedures were performed using standard sterile techniques in the operating room. At each follow-up visit, patients underwent a complete ophthalmological examination including visual acuity assessment, intraocular pressure, biomicroscopy, and posterior fundus examination. RESULTS: Ten patients presented sterile endophthalmitis with an onset time of 3.5±1.95 days. The clinical characteristics were mild pain, slight visual loss, conjunctival hyperemia, and various degrees of intraocular inflammation with microhypopyon. All cultures were negative. All patients were managed with topical steroids and antibiotics, except two, in whom, due to severe vitreous cells, intravitreal antibiotics were used. Three patients showed a transient elevation of intraocular pressure. Only 50% of the patients regained a visual acuity equal or better to the baseline visual acuity on file. CONCLUSION: The increasing number of intravitreal injections of bevacizumab applied every day, due to its widespread acceptance, might be one reason why the number of cases of sterile endophthalmitis is rising. Fast recognition and accurate differential diagnosis is important to avoid unnecessary treatments and long-term complications. The low incidence of this event should not preclude the use of intravitreal injections in eyes that could benefit greatly from this therapy. |
format | Online Article Text |
id | pubmed-4164286 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-41642862014-09-16 Acute sterile endophthalmitis following intravitreal bevacizumab: case series Orozco-Hernández, Axel Ortega-Larrocea, Ximena Sánchez-Bermúdez, Gustavo García-Aguirre, Gerardo Cantón, Virgilio Morales Velez-Montoya, Raul Clin Ophthalmol Original Research BACKGROUND: Since the ophthalmological community adopted the use of intravitreal bevacizumab as an accepted off-label treatment for neovascular diseases, the amount of knowledge regarding its effects and properties has been increasing continually. In the last few years, there have been an increasing number of reports about sterile intraocular inflammation and intraocular pressure elevations after intravitreal bevacizumab. In the following case series, we describe the clinical presentation and outcomes of ten consecutive cases of patients developing mild-to-severe sterile intraocular inflammation after intravitreal bevacizumab and their management. METHODS: This report presents a retrospective case series. We reviewed the medical records of ten consecutive patients from a group of 46, in whom repackaged bevacizumab in individual aliquots from two vials from the same batch were used. All surgical procedures were performed using standard sterile techniques in the operating room. At each follow-up visit, patients underwent a complete ophthalmological examination including visual acuity assessment, intraocular pressure, biomicroscopy, and posterior fundus examination. RESULTS: Ten patients presented sterile endophthalmitis with an onset time of 3.5±1.95 days. The clinical characteristics were mild pain, slight visual loss, conjunctival hyperemia, and various degrees of intraocular inflammation with microhypopyon. All cultures were negative. All patients were managed with topical steroids and antibiotics, except two, in whom, due to severe vitreous cells, intravitreal antibiotics were used. Three patients showed a transient elevation of intraocular pressure. Only 50% of the patients regained a visual acuity equal or better to the baseline visual acuity on file. CONCLUSION: The increasing number of intravitreal injections of bevacizumab applied every day, due to its widespread acceptance, might be one reason why the number of cases of sterile endophthalmitis is rising. Fast recognition and accurate differential diagnosis is important to avoid unnecessary treatments and long-term complications. The low incidence of this event should not preclude the use of intravitreal injections in eyes that could benefit greatly from this therapy. Dove Medical Press 2014-09-09 /pmc/articles/PMC4164286/ /pubmed/25228797 http://dx.doi.org/10.2147/OPTH.S66230 Text en © 2014 Orozco-Hernández et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. |
spellingShingle | Original Research Orozco-Hernández, Axel Ortega-Larrocea, Ximena Sánchez-Bermúdez, Gustavo García-Aguirre, Gerardo Cantón, Virgilio Morales Velez-Montoya, Raul Acute sterile endophthalmitis following intravitreal bevacizumab: case series |
title | Acute sterile endophthalmitis following intravitreal bevacizumab: case series |
title_full | Acute sterile endophthalmitis following intravitreal bevacizumab: case series |
title_fullStr | Acute sterile endophthalmitis following intravitreal bevacizumab: case series |
title_full_unstemmed | Acute sterile endophthalmitis following intravitreal bevacizumab: case series |
title_short | Acute sterile endophthalmitis following intravitreal bevacizumab: case series |
title_sort | acute sterile endophthalmitis following intravitreal bevacizumab: case series |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164286/ https://www.ncbi.nlm.nih.gov/pubmed/25228797 http://dx.doi.org/10.2147/OPTH.S66230 |
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