Acute intraocular inflammation after intravitreous injections of bevacizumab for treatment of neovascular age-related macular degeneration

Abstract

Purpose: Bevacizumab is an inhibitor of vascular endothelial growth factor widely used as an “off-label” treatment of neovascular age-related macular degeneration (AMD), despite the lack of clinical trial data on efficacy or safety of this drug. We describe acute intraocular inflammation after intravitreous injection of bevacizumab for the treatment of neovascular AMD. Design: A retrospective case series. Participants: Patients with neovascular AMD treated with intravitreous injection of bevacizumab from clinical practices in 2 states (Victoria and South Australia) in Australia. Methods: We retrospectively reviewed cases of acute intraocular inflammation after intravitreous injection of bevacizumab for the treatment of neovascular AMD. Main Outcome Measures: The detection and description of inflammation in a large cohort of patients. Results: There were 14 cases (11 women and 3 men), from a total of 1278 injections given. The mean age of patients was 83.7 years (range, 74–98). The majority had a prior injection of bevacizumab, with a mean number of injections of 2.7 (range, 1–6). Most patients presented within 24 hours of intravitreous injection, with rapid reduction in vision, but minimal discomfort. There were associated signs of ocular inflammation in the anterior and posterior segments of the eye. Visual acuity at presentation was substantially reduced compared with the preinjection acuity, although the vision rapidly improved with treatment over a period of 7–25 days toward preinjection visual acuity. Conclusions: Intravitreous injection of bevacizumab for the treatment of neovascular AMD may be associated with acute intraocular inflammation. Differentiation from infectious endophthalmitis is important for appropriate management of this condition.