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Sterile Inflammation after Intravitreal Injection of Aflibercept in a Korean Population.

Kim JY, You YS, Kwon OW, Kim SH - Korean J Ophthalmol (2015)

Bottom Line: The mean baseline visual acuity was 20 / 60, which decreased to 20 / 112 at diagnosis but ultimately recovered to 20 / 60.No patients had pain.Three of four patients were treated with a topical steroid, and all experienced improvement in their symptoms and signs of inflammation.

View Article: PubMed Central - PubMed

Affiliation: Nune Eye Hospital, Seoul, Korea.

ABSTRACT

Purpose: To report the frequency and clinical features of sterile inflammation after intravitreal aflibercept injection in a Korean population.

Methods: A single-center, retrospective study was performed in patients who received intravitreal aflibercept from July 2013 through January 2015.

Results: A total of four cases of post-injection sterile inflammation were identified from 723 aflibercept injections in 233 patients. Patients presented 1 to 13 days after intravitreal aflibercept injection (mean, 5 days). The mean baseline visual acuity was 20 / 60, which decreased to 20 / 112 at diagnosis but ultimately recovered to 20 / 60. Three cases had inflammatory cells in the anterior chamber (mean, 2.25+; range, 0 to 4+), and all cases had vitritis (mean, 3+; range, 2+ to 4+). No patients had pain. Only one patient underwent anterior chamber sampling (culture negative) and injection of antibiotics. Three of four patients were treated with a topical steroid, and all experienced improvement in their symptoms and signs of inflammation.

Conclusions: The overall incidence of sterile inflammation after intravitreal aflibercept injection in a Korean population was 4 of 723 injections (0.55%), or 4 of 233 patients (1.79%). Sterile inflammation after intravitreal aflibercept injection typically presents without pain, and the visual outcomes are generally favorable.

No MeSH data available.


Related in: MedlinePlus

Fundus photo images and a slit lamp photo image of a 69-year-old male patient (case 1). (A) Baseline fundus photo image, taken prior to the eighth intravitreal aflibercept injection. (B) Slit-lamp photo image. (C) Fundus photo image on the day of presentation. (D) Fundus photo image after resolution of inflammation.
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Figure 1: Fundus photo images and a slit lamp photo image of a 69-year-old male patient (case 1). (A) Baseline fundus photo image, taken prior to the eighth intravitreal aflibercept injection. (B) Slit-lamp photo image. (C) Fundus photo image on the day of presentation. (D) Fundus photo image after resolution of inflammation.

Mentions: A 68-year-old man with a history of CNV secondary to AMD treated with bevacizumab (right eye, OD) ×50, ranibizumab (OD) ×22, and aflibercept (OD) ×7 complained of blurred vision without pain two days after his eighth intravitreal aflibercept injection (OD). The patient's baseline BCVA was 0.63 (Snellen visual acuity), which then dropped to 0.125 after the aflibercept injection. On presentation, there were 4+ anterior chamber cells and 3+ vitreal cells in his right eye (Fig. 1A). An inflammatory strand in the anterior chamber was identified (Fig. 1B). The fundus showed haziness due to vitritis (Fig. 1C). We thought this presentation might be caused by post-intravitreal injection fungal endophthalmitis and performed aqueous humor sampling and administered an intravitreal injection of antibiotics (vancomycin 1.0 mg/0.1 mL, ceftazidime 2.25 mg/0.1 mL, and voriconazole 0.1 mg/0.1 mL) three days after the aflibercept injection. The patient was treated with prednisolone acetate 1% eye drops (Predforte) every six hours, moxifloxacin eye drops (Vigmox) every two hours, and voriconazole tablets (Vfend 200 mg; Pfizer, New York, NY, USA) 400 mg twice daily. The following day, the patient's BCVA improved to 0.2, the anterior chamber cells decreased to 2+, and the vitreous haziness decreased. The results of aqueous humor sampling (smear and culture) were negative, and treatment with voriconazole tablets was discontinued. The symptoms and signs of inflammation had gradually improved. Thirty-five days after the aflibercept injection, the anterior chamber and vitreous were clear (Fig. 1D), and BCVA improved to 0.63. Finally, we diagnosed this case as sterile inflammation after aflibercept injection. The patient received two additional aflibercept injections (OD, ninth and tenth injections), and showed no post-injection inflammation.


Sterile Inflammation after Intravitreal Injection of Aflibercept in a Korean Population.

Kim JY, You YS, Kwon OW, Kim SH - Korean J Ophthalmol (2015)

Fundus photo images and a slit lamp photo image of a 69-year-old male patient (case 1). (A) Baseline fundus photo image, taken prior to the eighth intravitreal aflibercept injection. (B) Slit-lamp photo image. (C) Fundus photo image on the day of presentation. (D) Fundus photo image after resolution of inflammation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
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Figure 1: Fundus photo images and a slit lamp photo image of a 69-year-old male patient (case 1). (A) Baseline fundus photo image, taken prior to the eighth intravitreal aflibercept injection. (B) Slit-lamp photo image. (C) Fundus photo image on the day of presentation. (D) Fundus photo image after resolution of inflammation.
Mentions: A 68-year-old man with a history of CNV secondary to AMD treated with bevacizumab (right eye, OD) ×50, ranibizumab (OD) ×22, and aflibercept (OD) ×7 complained of blurred vision without pain two days after his eighth intravitreal aflibercept injection (OD). The patient's baseline BCVA was 0.63 (Snellen visual acuity), which then dropped to 0.125 after the aflibercept injection. On presentation, there were 4+ anterior chamber cells and 3+ vitreal cells in his right eye (Fig. 1A). An inflammatory strand in the anterior chamber was identified (Fig. 1B). The fundus showed haziness due to vitritis (Fig. 1C). We thought this presentation might be caused by post-intravitreal injection fungal endophthalmitis and performed aqueous humor sampling and administered an intravitreal injection of antibiotics (vancomycin 1.0 mg/0.1 mL, ceftazidime 2.25 mg/0.1 mL, and voriconazole 0.1 mg/0.1 mL) three days after the aflibercept injection. The patient was treated with prednisolone acetate 1% eye drops (Predforte) every six hours, moxifloxacin eye drops (Vigmox) every two hours, and voriconazole tablets (Vfend 200 mg; Pfizer, New York, NY, USA) 400 mg twice daily. The following day, the patient's BCVA improved to 0.2, the anterior chamber cells decreased to 2+, and the vitreous haziness decreased. The results of aqueous humor sampling (smear and culture) were negative, and treatment with voriconazole tablets was discontinued. The symptoms and signs of inflammation had gradually improved. Thirty-five days after the aflibercept injection, the anterior chamber and vitreous were clear (Fig. 1D), and BCVA improved to 0.63. Finally, we diagnosed this case as sterile inflammation after aflibercept injection. The patient received two additional aflibercept injections (OD, ninth and tenth injections), and showed no post-injection inflammation.

Bottom Line: The mean baseline visual acuity was 20 / 60, which decreased to 20 / 112 at diagnosis but ultimately recovered to 20 / 60.No patients had pain.Three of four patients were treated with a topical steroid, and all experienced improvement in their symptoms and signs of inflammation.

View Article: PubMed Central - PubMed

Affiliation: Nune Eye Hospital, Seoul, Korea.

ABSTRACT

Purpose: To report the frequency and clinical features of sterile inflammation after intravitreal aflibercept injection in a Korean population.

Methods: A single-center, retrospective study was performed in patients who received intravitreal aflibercept from July 2013 through January 2015.

Results: A total of four cases of post-injection sterile inflammation were identified from 723 aflibercept injections in 233 patients. Patients presented 1 to 13 days after intravitreal aflibercept injection (mean, 5 days). The mean baseline visual acuity was 20 / 60, which decreased to 20 / 112 at diagnosis but ultimately recovered to 20 / 60. Three cases had inflammatory cells in the anterior chamber (mean, 2.25+; range, 0 to 4+), and all cases had vitritis (mean, 3+; range, 2+ to 4+). No patients had pain. Only one patient underwent anterior chamber sampling (culture negative) and injection of antibiotics. Three of four patients were treated with a topical steroid, and all experienced improvement in their symptoms and signs of inflammation.

Conclusions: The overall incidence of sterile inflammation after intravitreal aflibercept injection in a Korean population was 4 of 723 injections (0.55%), or 4 of 233 patients (1.79%). Sterile inflammation after intravitreal aflibercept injection typically presents without pain, and the visual outcomes are generally favorable.

No MeSH data available.


Related in: MedlinePlus