Severe intraocular inflammation following intraviteal injection of Bevacizumab: a study in phakic and pseudophakic eyes

Session Details

Session Title: Endophthalmitis/ Ocular Infections/ Miscellaneous

Session Date/Time: Tuesday 10/10/2017 | 08:00-10:30

Paper Time: 08:43

Venue: Room 4.6

First Author: : N.Borah INDIA

Co Author(s): :    S. Ahmed                    

Abstract Details

Purpose:

A prospective comparative study between phakic and pseudophakic eyes to identify the nature of clinical presentations and treatment outcome due to severe intraocular inflammation(SII) following intravitreal injection of bevacizumab(IVB) for DME.

Setting:

This prospective interventional study was done at Guwahati Eye Institute and Research Centre,India. A report of severe intraocular inflammation, it’s effects in pseudophakic eyes after off label intravitreal injection of bevacizumab in DME. Clinical presentations and outcome of severe intraocular inflammation(in cluster) were studied/compared in phakic and pseudophakic eyes.

Methods:

Period of study:1-4-2013 to 31-3-2016. Pre, post tt BCVA,IOP,anterior, posterior segment examinations and systemic investigations were routinely done.IVB(1.25mg) were prepared from a single vial(4 ml/100mg) and used on same day.Injections were given in O.T. with proper aseptic care and technique & then followed on 1st,7th day,1 month.

Results:

2640 eyes(2640 pts) received IVB. Pseudophakic=977 eyes, phakic=1663 eyes. Pseudophakic eyes received IVB 4 weeks after phacoemulsification surgery. On July, 2016; 8 eyes(phakic-4,pseudophakic-4) developed SII on 1st post-injection day. On presentation- loss of vision(8), redness(8), pain(8), watering(8). Anterior,posterior segment findings- hypopyon(2),IOP rise(2),corneal edema(2). Pseudophakic eyes also had- vitreous inflammation(n=4), inflammatory deposits on anterior surface of the IOLs(n=4). VA improved to baseline(n=8). But recovery was prolonged in pseudophakic eyes(Mean; phakic- 2 weeks,psudophakic-4 weeks ). Aqueous culture- negative(n=8). All 8 eyes responded to treatment with prednisolone, moxifloxacin, cycloplegic E/D. Presenting VA- FC-1ft to 6/24, final VA- 6/12 to 6/18.(P=0.608, confidence level 0.95).

Conclusions:

Severe intraocular inflammation mimiking sterile endophthalmitis may develop in cluster following IVB. Inflammation tend to be more severe in the pseudophakic eyes(n=4) than phakic eyes(n=4) with delayed recovery. As break down of blood retinal barrier occur following diabetic retinopathy and post cataract surgery, both may contribute towards more acute menifestations of sterile inflammation in the pseudophakic eyes. Pseudophakic eyes with diabetic macular edema requiring IVB should be delayed until 6 weeks(post operatively). Bilateral simultaneous injections of bevacizumab from a single vial is not advisable.

Financial Disclosure:

NONE