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Severe intraocular inflammation after intravitreal injection of bevacizumab

Tatsuhiko Sato1, Kazuyuki Emi, Toshihide Ikeda

  • 1Department of Ophthalmology, Osaka Rosai Hospital, Sakai, Japan.

Ophthalmology
|December 25, 2009
PubMed
Abstract

Insights

Intravitreal bevacizumab injections from a specific lot (B3003B01) were linked to severe sterile endophthalmitis, mimicking toxic anterior segment syndrome (TASS). This highlights a potential risk associated with this batch of bevacizumab, necessitating careful monitoring.

Area of Science:

  • Ophthalmology
  • Pharmacology
  • Infectious Diseases

Background:

  • Intravitreal injections are common treatments for various ocular conditions.
  • Bevacizumab is an anti-vascular endothelial growth factor (VEGF) agent frequently used off-label for intraocular neovascularization.
  • Severe intraocular inflammation post-injection can lead to significant vision loss.

Observation:

  • A retrospective case series reviewed 35 eyes treated with intravitreal bevacizumab from lot B3003B01.
  • Five cases (14.3%) developed severe intraocular inflammation with characteristics of toxic anterior segment syndrome (TASS).
  • Cultures from aqueous and vitreous samples were negative, suggesting a sterile inflammatory process.

Findings:

  • The observed inflammation presented with anterior chamber reaction and hypopyon in most cases.
  • Best-corrected visual acuity (BCVA) and endothelial cell density showed no statistically significant changes before and after the event.
  • The clinical presentation mimicked TASS but occurred after intravitreal administration of bevacizumab.

Implications:

  • This suggests that intravitreal bevacizumab, specifically lot B3003B01, can induce sterile endophthalmitis with TASS-like features.
  • Ophthalmologists should be aware of this potential complication and monitor patients closely after bevacizumab injections.
  • Further investigation into the specific lot of bevacizumab may be warranted to identify the causative agent or mechanism.

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