Ocular inflammation associated with antivascular endothelial growth factor treatment

To describe the diagnosis and management of intraocular inflammation following antivascular endothelial growth factor (VEGF) injections.

Inflammation following intravitreal anti-VEGF injections can cause a dramatic reduction in acuity. Differentiating factors from truly infectious endophthalmitis include a lack of pain, redness, or hypopyon, although none of these factors is diagnostic. A high suspicion of infectious endophthalmitis should trigger a prompt vitreous tap and injection of intravitreal antibiotics. Conversely, if noninfectious endophthalmitis is suspected, close observation with frequent topical steroids is warranted.

Most eyes with noninfectious endophthalmitis following anti-VEGF injection recover within 1 month to baseline acuity with topical corticosteroid treatment. Mechanisms hypothesized to explain postinjection inflammation include patient-specific, delivery-specific, and medication-specific factors.