Sterile endophthalmitis after intravitreal injection of bevacizumab obtained from a single batch.
OBJECTIVE
The purpose of this study was to report 14 consecutive cases of endophthalmitis after intravitreal injection of bevacizumab (Avastin; Roche, Basel, Switzerland) obtained from a single batch.


METHODS
One vial of bevacizumab (100 mg/4 mL) was divided into 20 sterile injections and kept at 4 degrees C before use. Bevacizumab (1.25 mg/0.05 mL) was injected intravitreally into 19 eyes of 15 patients to treat macular edema or choroidal neovascularization. All treatments were performed within 1 week of the bevacizumab, which was from a single batch, being aliquotted into the 20 doses.


RESULTS
Of the 19 eyes, 14 showed moderate to severe ocular inflammation immediately after injection. Cultures of aqueous humor and vitreous from 5 eyes were negative for bacteria and fungi. Eyes with moderate inflammation received topical or systemic antibiotics and steroid treatment. Five eyes with severe inflammation underwent pars plana vitrectomy because of dense vitreous opacity. Visual acuity returned to preendophthalmitis levels in 12 eyes but had decreased in 2 eyes at 1 month after the injection.


CONCLUSIONS
Intravitreal injection of bevacizumab can cause sterile endophthalmitis. Most inflammation occurred within a few days after the intravitreous injection of the bevacizumab, but treatment with antibiotics, steroids, and/or vitrectomy was effective, and the prognosis was good in most cases.
Yamashiro
Kenji
K
Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Kawahara, Shogoin, Sakyo, Kyoto 606-8507, Japan. yamashro@kuhp.kyoto-u.ac.jp
Tsujikawa
Akitaka
A
Miyamoto
Kazuaki
K
Oh
Hideasu
H
Otani
Atsushi
A
Tamuara
Hiroshi
H
Ooto
Sotaro
S
Sasahara
Manabu
M
Iwama
Daisuke
D
Yoshimura
Nagahisa
N
D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy; D009877:Endophthalmitis / Q000139:chemically induced* / Q000628:therapy; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007267:Injections; D008268:Macular Degeneration / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D012170:Retinal Vein Occlusion / Q000188:drug therapy; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D014821:Vitrectomy; D014822:Vitreous Body
D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab