Sterile Intraocular Inflammation Following Intravitreal Injections: Pathogenesis, Clinical Features, and Management

Area of Science:

• Ophthalmology
• Retinal Diseases
• Immunology

Background:

• Intravitreal injections are vital for treating retinal diseases but can lead to vision-threatening noninfectious intraocular inflammation.
• This inflammation can mimic infectious endophthalmitis, complicating diagnosis and treatment.

Purpose of the Study:

• To review current knowledge on post-intravitreal injection inflammation, focusing on sterile inflammation and retinal vasculitis.
• To discuss the pathogenesis, clinical presentations, and management strategies for these inflammatory complications.

Main Methods:

• Systematic review of current literature on intravitreal therapy complications.
• Focus on inflammation associated with anti-VEGF agents (e.g., brolucizumab) and complement inhibitors (e.g., pegcetacoplan).

Main Results:

• Inflammation is multifactorial, involving immune responses, drug properties, and administration techniques.
• Brolucizumab shows higher inflammation rates than ranibizumab or aflibercept.
• Clinical presentations vary, including uveitis, vitritis, and retinal vasculitis.

Conclusions:

• Prompt recognition and management, including corticosteroids and drug discontinuation, are essential for visual outcomes.
• Standardized evaluation of postinjection inflammation is critical for patient safety and vision preservation as new therapies emerge.