Ocular Complications of Intravitreal Avastin: a Report from Tobruk Medi-cal Center

Authors

  • Fathy A. Abdolmejed Ophthalmology Department, Faculty of Medicine, Tobruk University, Libya
  • Ghamela S. Ali Pediatric Department, Faculty of Medicine, Tobruk University, Libya

DOI:

https://doi.org/10.54172/mjsc.v35i2.317

Keywords:

Avastin, Diabetes Complications, Intravitreal Injection, Tobruk

Abstract

A retrospective statistical study was done at the ophthalmology department of Tobruk Medical Center on all the patients who received intravitreal medication with Avastin (anti-VEGF (anti-vascular endothelial growth factor)) in the period between August 1st and December 31st, 2018. It is aimed to report the complications of the intravitreal injection (IVI) and how they were managed. Out of the 56 recorded patients, there were 32 (51.9 %) females, all the patients received multiple intravitreal injections, with a total number of 131 injections. The average age of the patients was 56.5 years (ranged from 40-70 years). The most common complications after intravitreal injection were subconjunctival hemorrhage (19%), discomfort/pain (13.7%), blurring of vision (6 %), leaking at injection site (4.6%), floaters (3%), and increase intraocular pressure (IOP) in (13.7%). Six cases out of the eighteen that had high IOP received Diamox (Acetazolamide) Tab. 250 mg one-two hours before the time of injection which did not prevent the post-injection spike of IOP and that was statistically not significant (P=0.09). Thirteen eyes (10 %) developed sudden loss of vision due to sudden increase in IOP immediately after the injection, and all the cases of the high IOP were managed by anterior chamber paracentesis and the vision also improved. Endophthalmitis was recorded in only one case (0.8%), at the third-day post intraocular Avastin injection, the causative microorganism was unknown and treated with intravitreal antibiotics (vancomycin) along with topical and systemic antibiotics and steroids, but the patient did not recover until pars plana vitrectomy was done to him, and the patient recovered his preoperative vision. The patients who had glaucoma or rubeosis iridis suffered significantly (P = 0.01) from an increase in IOP levels (digitally measured) after injection with Avastin, while most other patients who didn't have both pathologies did not suffer from an increase in IOP. It can be concluded that despite having a dramatic effect on the quality of life by improving the central vision, Anti-VEGF can cause serious complications that could be prevented by early diagnosis and treatment

Downloads

Download data is not yet available.

References

Aiello, L. P., Brucker, A. J., Chang, S., Cun-ningham, E. T., Jr, D'Amico, D. J., Flynn, H. W., Jr, Grillone, L. R., Hutcherson, S., Liebmann, J. M., O'Bri-en, T. P., Scott, I. U., Spaide, R. F., Ta, C., & Trese, M. T. (2004). Evolving guidelines for intravitreous injec-tions. Retina (Philadelphia, Pa.), 24(5 Suppl), S3–S19. DOI: https://doi.org/10.1097/00006982-200410001-00002

Barry P, Cordovés L, Gardner S.(2013). ESCRS Guidelines for Pre-vention and Treatment of Endophthal-mitis following Cataract Surgery: Data, Dilemmas and Conclusions. Paper Pre-sented at the European Society of Cata-ract and Refractive Surgeons. Dublin, Ireland: 2013.https://www.escrs.org/downloads/Endophthalmitis-Guidelines.pdf. Ac-cessed July 25, 2020

Bertino J. S., Jr (2009). Impact of antibiotic re-sistance in the management of ocular infections: the role of current and future antibiotics. Clinical ophthalmology (Auckland, N.Z.), 3, 507–521. DOI: https://doi.org/10.2147/OPTH.S5778

Callegan, M. C., Engelbert, M., Parke, D. W., 2nd, Jett, B. D., & Gilmore, M. S. (2002). Bacterial endophthalmitis: epi-demiology, therapeutics, and bacterium-host interactions. Clinical microbiology reviews, 15(1), 111–124. DOI: https://doi.org/10.1128/CMR.15.1.111-124.2002

Damasceno, N. P., Horowitz, S. A., & Damasceno, E. F. (2016). Leuconostoc as a Cause of Endophthalmitis Post-intravitreal Injection of Ranibi-zumab. Ocular immunology and in-flammation, 24(1), 118–119. DOI: https://doi.org/10.3109/09273948.2014.898073

Dancer, S. J., Stewart, M., Coulombe, C., Gre-gori, A., & Virdi, M. (2012). Surgical site infections linked to contaminated surgical instruments. The Journal of hospital infection, 81(4), 231–238. DOI: https://doi.org/10.1016/j.jhin.2012.04.023

Dhoot S. B., Kunjukunju N., Sabates N. (2013).The role of prophylactic antibi-otic use in prevention of endophthalmitis following intravitreal injection of anti-vascular endothelial growth factor agents: a meta-analysis. Open J Oph-thalmol., 3(2):46–49. DOI: https://doi.org/10.4236/ojoph.2013.32012

Fang, Y. T., Chien, L. N., Ng, Y. Y., Chu, H. F., Chen, W. M., Cheng, C. Y., & Wu, S. C. (2006). Association of hospital and surgeon operation volume with the incidence of postoperative endophthal-mitis: Taiwan experience. Eye (London, England) , 20(8), 900–907. DOI: https://doi.org/10.1038/sj.eye.6702045

Frenkel, M.P., Haji, S.A. and Frenkel, R.E. (2010) Effect of Prophylactic Intraocular Pressure-Lowering Medication on Intraocular Pressure Spikes after Intrav-itreal Injections. Arch Ophthalmol, 128, 1523-1527. DOI: https://doi.org/10.1001/archophthalmol.2010.297

Hoevenaars, N. E., Gans, D., Missotten, T., van Rooij, J., Lesaffre, E., & van Meurs, J. C. (2012). Suspected bacterial endoph-thalmitis following intravitreal anti-VEGF injection: case series and litera-ture review. Ophthalmologica. Journal international d'ophtalmologie. Interna-tional journal of ophthalmology. Zeitschrift fur Augenheilkunde, 228(3), 143–147. DOI: https://doi.org/10.1159/000339584

Hoguet, A., Chen, P. P., Junk, A. K., Mruthyunjaya, P., Nouri-Mahdavi, K., Radhakrishnan, S., Takusagawa, H. L., & Chen, T. C. (2019). The Effect of Anti-Vascular Endothelial Growth Fac-tor Agents on Intraocular Pressure and Glaucoma: A Report by the American Academy of Ophthalmolo-gy. Ophthalmology, 126(4), 611–622. DOI: https://doi.org/10.1016/j.ophtha.2018.11.019

Hollands, H., Wong, J., Bruen, R., Campbell, R. J., Sharma, S., & Gale, J. (2007). Short-term intraocular pressure changes after intravitreal injection of bevaci-zumab. Canadian journal of ophthal-mology. Journal canadien d'ophtalmol-ogie, 42(6), 807–811. DOI: https://doi.org/10.3129/i07-172

Oztas, Z., Akkin, C., Afrashi, F., & Nalcaci, S. (2016). The short-needle intravitreal in-jection technique. International journal of ophthalmology, 9(6), 929–930.

Park, J. C., Ramasamy, B., Shaw, S., Prasad, S., & Ling, R. H. (2014). A prospective and nationwide study investigating en-dophthalmitis following pars plana vitrectomy: incidence and risk fac-tors. The British journal of ophthalmol-ogy, 98(4), 529–533. DOI: https://doi.org/10.1136/bjophthalmol-2013-304485

Pulido, J. S., Pulido, C. M., Bakri, S. J., McCannel, C. A., & Cameron, J. D. (2007). The use of 31-gauge needles and syringes for intraocular injections. Eye (London, England), 21(6), 829–830. DOI: https://doi.org/10.1038/sj.eye.6702514

Qureshi, N. A., Mansoor, H., Ahmad, S., Zafar, S., & Asif, M. (2016). Reducing intra-ocular-pressure spike after intravitreal-bevacizumab injection with ocular de-compression using a sterile cotton swab soaked in proparacaine 0.5%: A quasi-experimental study. Taiwan journal of ophthalmology, 6(2), 75–78. DOI: https://doi.org/10.1016/j.tjo.2015.12.003

Sachdeva, M. M., Moshiri, A., Leder, H. A., & Scott, A. W. (2016). Endophthalmitis following intravitreal injection of anti-VEGF agents: long-term outcomes and the identification of unusual micro-organisms. Journal of ophthalmic in-flammation and infection, 6(1), 2. DOI: https://doi.org/10.1186/s12348-015-0069-5

Semeraro, F., Morescalchi, F., Duse, S., Gambicorti, E., Cancarini, A., & Costagliola, C. (2015). Pharmacokinetic and Pharmacodynamic Properties of Anti-VEGF Drugs After Intravitreal In-jection. Current drug metabo-lism, 16(7), 572–584. DOI: https://doi.org/10.2174/1389200216666151001120831

Shah, Chirag P; Garg, Sunir J; Vander, James F; Brown, Gary C; Kaiser, Richard S; Haller, Julia A; and The Post-Injection Endophthalmitis (PIE) Study Team (2011). "Outcomes and risk factors as-sociated with endophthalmitis after in-travitreal injection of anti-vascular en-dothelial growth factor agents." Oph-thalmology, 118 (10): 2028-2034. DOI: https://doi.org/10.1016/j.ophtha.2011.02.034

Solborg Bjerrum, S., Kiilgaard, J. F., Mikkelsen, K. L., & la Cour, M. (2013). Outsourced cataract surgery and postoperative endophthalmitis. Acta ophthalmo-logica, 91(8), 701–708. DOI: https://doi.org/10.1111/aos.12279

Song, S., Yu, X. B., & Dai, H. (2016). Effect of prophylactic intraocular pressure-lowering medication (brinzolamide) on intraocular pressure after ranibizumab intravitreal injection: A case-control study. Indian journal of ophthalmolo-gy, 64(10), 762–766. DOI: https://doi.org/10.4103/0301-4738.195006

Tufan, H.A., Vural, A.H., Gencer, B., Kara, S., Arıkan, S., & Yuksel, E. (2013). Bacte-rial Contamination of Needles Used for Intravitreal Injections: Comparison be-tween 27-gauge and 30-gauge Nee-dles. Ocular Immunology and Inflam-mation, 21, 366 – 370, DOI: https://doi.org/10.3109/09273948.2013.801988

Uyar, E., Ulas, F., Sahin, S., & Celebi, S. (2019). Major factors affecting intraoc-ular pressure spike after intravitreal ranibizumab injection: Vitreous reflux and its amount. European Journal of Ophthalmology, 29(4), 361–367. DOI: https://doi.org/10.1177/1120672119836613

Downloads

Published

2020-06-30

How to Cite

Abdolmejed , F. A. ., & Ali, G. S. . (2020). Ocular Complications of Intravitreal Avastin: a Report from Tobruk Medi-cal Center. Al-Mukhtar Journal of Sciences, 35(2), 85–93. https://doi.org/10.54172/mjsc.v35i2.317

Issue

Section

Research Articles

Categories