Clinical manifestations of intravitreal bortezomib injection

PURPOSE: To describe the clinical presentation and ocular manifestations of intravitreal bortezomib. OBSERVATIONS: Retrospective chart review of five patients who inadvertently received intravitreal injection of bortezomib, instead of bevacizumab, showed that all patients presented hyperacutely within 24–72 hours of the injection with pain and severe vision loss. Examination revealed a fibrinous anterior uveitis, corneal edema, and choroidal effusion associated with a shallow anterior chamber and secondary angle closure glaucoma. Significant vitritis was notably absent. Severe retinal vascular attenuation and optic atrophy, and sometimes even retinal infarction or detachment, followed. Four of the five patients rapidly progressed to no light perception vision. Vitreous gram stain and cultures were negative in all eyes. CONCLUSIONS AND IMPORTANCE: Intravitreal bortezomib is severely toxic to the eye. Special safeguards should be instituted for the dispensing of intravitreal medications.