Acute sterile endophthalmitis following intravitreal bevacizumab: case series

Axel Orozco-Hernández,1 Ximena Ortega-Larrocea,1 Gustavo Sánchez-Bermúdez,1 Gerardo García-Aguirre,1 Virgilio Morales Cantón,1 Raul Velez-Montoya2 1Retina Department, Asociación para Evitar la Ceguera en México IAP, Mexic...

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Autores principales:	Orozco-Hernández A, Ortega-Larrocea X, Sánchez-Bermúdez G, García-Aguirre G, Morales Canton V, Velez-Montoya R
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/1beec655ca5e4de99e00bf9f667f03f9
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spelling	oai:doaj.org-article:1beec655ca5e4de99e00bf9f667f03f92021-12-02T02:17:09ZAcute sterile endophthalmitis following intravitreal bevacizumab: case series1177-5483https://doaj.org/article/1beec655ca5e4de99e00bf9f667f03f92014-09-01T00:00:00Zhttp://www.dovepress.com/acute-sterile-endophthalmitis-following-intravitreal-bevacizumab-case--peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483 Axel Orozco-Hernández,1 Ximena Ortega-Larrocea,1 Gustavo Sánchez-Bermúdez,1 Gerardo García-Aguirre,1 Virgilio Morales Cantón,1 Raul Velez-Montoya2 1Retina Department, Asociación para Evitar la Ceguera en México IAP, Mexico City, Mexico; 2Department of Ophthalmology, University of Colorado School of Medicine, Rocky Mountain Lions Eye Institute, Aurora, CO, USA Background: Since the ophthalmological community adopted the use of intravitreal bevacizumab as an accepted off-label treatment for neovascular diseases, the amount of knowledge regarding its effects and properties has been increasing continually. In the last few years, there have been an increasing number of reports about sterile intraocular inflammation and intraocular pressure elevations after intravitreal bevacizumab. In the following case series, we describe the clinical presentation and outcomes of ten consecutive cases of patients developing mild-to-severe sterile intraocular inflammation after intravitreal bevacizumab and their management. Methods: This report presents a retrospective case series. We reviewed the medical records of ten consecutive patients from a group of 46, in whom repackaged bevacizumab in individual aliquots from two vials from the same batch were used. All surgical procedures were performed using standard sterile techniques in the operating room. At each follow-up visit, patients underwent a complete ophthalmological examination including visual acuity assessment, intraocular pressure, biomicroscopy, and posterior fundus examination. Results: Ten patients presented sterile endophthalmitis with an onset time of 3.5±1.95 days. The clinical characteristics were mild pain, slight visual loss, conjunctival hyperemia, and various degrees of intraocular inflammation with microhypopyon. All cultures were negative. All patients were managed with topical steroids and antibiotics, except two, in whom, due to severe vitreous cells, intravitreal antibiotics were used. Three patients showed a transient elevation of intraocular pressure. Only 50% of the patients regained a visual acuity equal or better to the baseline visual acuity on file. Conclusion: The increasing number of intravitreal injections of bevacizumab applied every day, due to its widespread acceptance, might be one reason why the number of cases of sterile endophthalmitis is rising. Fast recognition and accurate differential diagnosis is important to avoid unnecessary treatments and long-term complications. The low incidence of this event should not preclude the use of intravitreal injections in eyes that could benefit greatly from this therapy. Keywords: complications, vitrectomy, intravitreal antibiotics, pseudoendophthalmitis, bevacizumabOrozco-Hernández AOrtega-Larrocea XSánchez-Bermúdez GGarcía-Aguirre GMorales Canton VVelez-Montoya RDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2014, Iss default, Pp 1793-1799 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Orozco-Hernández A Ortega-Larrocea X Sánchez-Bermúdez G García-Aguirre G Morales Canton V Velez-Montoya R Acute sterile endophthalmitis following intravitreal bevacizumab: case series
description	Axel Orozco-Hernández,1 Ximena Ortega-Larrocea,1 Gustavo Sánchez-Bermúdez,1 Gerardo García-Aguirre,1 Virgilio Morales Cantón,1 Raul Velez-Montoya2 1Retina Department, Asociación para Evitar la Ceguera en México IAP, Mexico City, Mexico; 2Department of Ophthalmology, University of Colorado School of Medicine, Rocky Mountain Lions Eye Institute, Aurora, CO, USA Background: Since the ophthalmological community adopted the use of intravitreal bevacizumab as an accepted off-label treatment for neovascular diseases, the amount of knowledge regarding its effects and properties has been increasing continually. In the last few years, there have been an increasing number of reports about sterile intraocular inflammation and intraocular pressure elevations after intravitreal bevacizumab. In the following case series, we describe the clinical presentation and outcomes of ten consecutive cases of patients developing mild-to-severe sterile intraocular inflammation after intravitreal bevacizumab and their management. Methods: This report presents a retrospective case series. We reviewed the medical records of ten consecutive patients from a group of 46, in whom repackaged bevacizumab in individual aliquots from two vials from the same batch were used. All surgical procedures were performed using standard sterile techniques in the operating room. At each follow-up visit, patients underwent a complete ophthalmological examination including visual acuity assessment, intraocular pressure, biomicroscopy, and posterior fundus examination. Results: Ten patients presented sterile endophthalmitis with an onset time of 3.5±1.95 days. The clinical characteristics were mild pain, slight visual loss, conjunctival hyperemia, and various degrees of intraocular inflammation with microhypopyon. All cultures were negative. All patients were managed with topical steroids and antibiotics, except two, in whom, due to severe vitreous cells, intravitreal antibiotics were used. Three patients showed a transient elevation of intraocular pressure. Only 50% of the patients regained a visual acuity equal or better to the baseline visual acuity on file. Conclusion: The increasing number of intravitreal injections of bevacizumab applied every day, due to its widespread acceptance, might be one reason why the number of cases of sterile endophthalmitis is rising. Fast recognition and accurate differential diagnosis is important to avoid unnecessary treatments and long-term complications. The low incidence of this event should not preclude the use of intravitreal injections in eyes that could benefit greatly from this therapy. Keywords: complications, vitrectomy, intravitreal antibiotics, pseudoendophthalmitis, bevacizumab
format	article
author	Orozco-Hernández A Ortega-Larrocea X Sánchez-Bermúdez G García-Aguirre G Morales Canton V Velez-Montoya R
author_facet	Orozco-Hernández A Ortega-Larrocea X Sánchez-Bermúdez G García-Aguirre G Morales Canton V Velez-Montoya R
author_sort	Orozco-Hernández A
title	Acute sterile endophthalmitis following intravitreal bevacizumab: case series
title_short	Acute sterile endophthalmitis following intravitreal bevacizumab: case series
title_full	Acute sterile endophthalmitis following intravitreal bevacizumab: case series
title_fullStr	Acute sterile endophthalmitis following intravitreal bevacizumab: case series
title_full_unstemmed	Acute sterile endophthalmitis following intravitreal bevacizumab: case series
title_sort	acute sterile endophthalmitis following intravitreal bevacizumab: case series
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/1beec655ca5e4de99e00bf9f667f03f9
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Acute sterile endophthalmitis following intravitreal bevacizumab: case series

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