[Intraocular inflammation after intravitreal injection of second-generation anti-VEGF agents observed in a tertiary...

To describe cases of intraocular inflammation (IOI) observed after intravitreal injections (IVI) of second-generation anti-VEGF agents in a university hospital over 12months in 2024.

This was a case series observed in a retina referral center over a 12-month period. Visual acuity at baseline and at the time of the IOI episode, clinical presentation, time until symptom onset, intraocular pressure, and clinical course were analyzed. The number of injections received, treatment-naïve versus switch status, and therapeutic management were also recorded.

Among 23 eyes of 19 patients, IOI occurred on average 17days after injection, following a mean of 4.4 injections. The implicated drug was faricimab in 19 eyes and brolucizumab in 4 eyes. The clinical presentation consisted of acute anterior uveitis with keratic precipitates. Ocular hypertension was more frequent with faricimab-associated IOI (52%). Vitritis was associated in 12 cases, and one case of occlusive vasculitis was observed. Mean best-corrected visual acuity was 64.2 ETDRS letters at baseline, 47.7 letters during the IOI episode, and 63.8 letters after resolution. Four atypical presentations were described.

IOI following intravitreal injections represents a safety signal, particularly since the introduction of next-generation anti-VEGF agents. Due to the tertiary-referral nature of our center, we cannot determine the prevalence of IOI in this study. Nevertheless, it was estimated at 3.9% of patients in another cohort of our department. Its occurrence may limit the use of these drugs, necessitating close monitoring and enhanced patient counseling regarding warning symptoms.

Next-generation anti-VEGF agents carry a non-negligible risk of IOI, most often of moderate severity and with good outcomes after topical corticosteroids. Symptoms suggestive of IOI, as well as confirmed IOI, should contraindicate further injections with the same molecule. No current consensus exists to guide the choice of an alternative anti-VEGF agent after IOI, aside from the clear contraindication for brolucizumab.