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Use of Rabbit Eyes in Pharmacokinetic Studies of Intraocular Drugs
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LARGE SILICONE DROPLETS AFTER INTRAVITREAL BEVACIZUMAB (AVASTIN).

Robert L Avery1, Alessandro A Castellarin, Dilsher S Dhoot

  • 1California Retina Consultants, Santa Barbara, California.

Retinal Cases & Brief Reports
|March 17, 2017
PubMed
Summary

A recent increase in silicone oil droplets after intravitreal bevacizumab injections was observed. This complication, characterized by a unique floater and ultrasound pattern, requires careful patient evaluation and investigation.

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Area of Science:

  • Ophthalmology
  • Retinal diseases
  • Ocular drug delivery

Background:

  • Intravitreal bevacizumab is a widely used anti-vascular endothelial growth factor agent, despite its off-label status for intraocular use.
  • Recent regulatory changes in compounding pharmacies aim to enhance pharmaceutical safety.

Observation:

  • A significant rise in symptomatic, large silicone oil droplets post-intravitreal bevacizumab injections was noted.
  • Twenty-three cases occurred in five months, contrasting with one case in the preceding decade.

Findings:

  • Patients reported a distinct circular floater (dark ring, bright center) immediately after injections.
  • B-scan ultrasonography revealed a characteristic reverberation pattern.
  • No vision loss or inflammation occurred, but patient annoyance prompted consideration of vitrectomy.

Implications:

  • Increased vigilance for silicone oil droplets is necessary, aided by characteristic symptoms and B-scan findings.
  • Informed consent discussions should include this potential complication.
  • Further investigation is warranted to determine the cause, particularly concerning the use of one-piece insulin syringes with compounded bevacizumab.