Characteristics of severe intraocular inflammation following intravitreal injection of bevacizumab (Avastin)
Characteristics of severe intraocular inflammation following intravitreal injection of bevacizumab (Avastin)
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DOI：
10.1136/bjo.2008.138479
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发表时间：
2009-04-01
影响因子：
4.1
通讯作者：
Schmidt-Erfurth, U.
中科院分区：
文献类型：
--
作者：
Georgopoulos, M.;Polak, K.;Schmidt-Erfurth, U.
背景/目的：报告玻璃体内注射贝伐单抗（阿瓦斯汀）后发生的一系列严重眼内炎症事件。在世界范围内，这种手术的数量迅速增加，罕见的并发症，如眼内炎症、眼内炎或眼内出血，在临床常规中越来越重要。方法：这是一个单中心回顾性介入病例系列，在一个转诊中心连续观察了大约2500次注射后，在玻璃体内注射贝伐单抗后出现严重眼内炎症的8例患者。对玻璃体注射后发生严重眼内炎症的患者进行临床评估，包括裂隙灯检查、最佳矫正Snellen视力（VA）、裂隙灯摄影、光学相干断层扫描和荧光素血管造影。结果：患者在注射后2天注意到无痛性VA下降。所有患者均有明显的前房反应，光斑和细胞增加，但无垂体。典型的后段表现包括假肉芽肿方面的玻璃体细胞浸润。由于最初的临床表现怀疑为眼内炎，3例患者接受了全身抗生素治疗，但最终诊断为葡萄膜炎。5例患者表现为玻璃体炎特有的假肉芽肿性玻璃体浸润，仅行局部治疗。结论：贝伐单抗注射引起的炎症的特征包括早发性无痛性VA损失，大部分没有结膜或睫状体注射。患者对全身或局部可的松治疗有反应，恢复缓慢，但无永久性损伤。玻璃体出血和感染性眼内炎可根据病程和症状加以鉴别。
Background/aims: To report a series of severe intraocular inflammatory events following intravitreal injections of bevacizumab (Avastin). This procedure is performed on a rapidly increasing number worldwide, and rare complications such as intraocular inflammation, endophthalmitis or intraocular haemorrhage are gaining in importance in clinical routine.Methods: This is a single-centre retrospective interventional case series of eight patients with severe intraocular inflammation after intravitreal injection of bevacizumab at one referral centre consecutively seen out of approximately a total of 2500 injections performed in that time period. Patients who developed severe intraocular inflammation after intravitreal injection were evaluated clinically, including slit-lamp examination, best-corrected Snellen visual acuity (VA), slit-lamp photography, optical coherence tomography and fluorescein angiography prior to the event and during follow-up.Results: Patients noticed a painless drop in VA up to 2 days following the injection. All patients had a marked anterior chamber reaction with increased flare and cells, but no hypopyon. Typical posterior segment findings included vitreous cellular infiltrates of pseudogranulomatous aspect. Due to their initial clinical aspect suspicious of an endophthalmitis, three cases were treated with systemic antibiotics, but the final diagnosis was uveitis. Five cases showed a characteristic pseudogranulomatous vitreous infiltration as seen in vitritis and were treated only topically.Conclusions: Characteristic features of an inflammation induced by bevacizumab injection include an early onset with painless loss in VA mostly without conjunctival or ciliary injection. Patients respond to systemic or topical cortisone treatment with slow recovery but without permanent damage. Vitreous haemorrhage and infectious endophthalmitis might be differentiated by time course and symptoms.