title: Avastin doesn't blind people, people blind people.
abstract: OBJECTIVE
  To review the appropriate preparation of bevacizumab for intravitreal injection by compounding pharmacies with specific recommendations designed to prevent microbial contamination.
  
  
  METHODS
  Perspective.
  
  
  METHODS
  A review and discussion of compounding issues with supporting literature, clinical experience, illustrations, and expert opinion.
  
  
  RESULTS
  Closer examination of the events surrounding the recent clusters of infectious endophthalmitis cases occurring after the intravitreal injection of bevacizumab suggest that the vision loss is not the result of the drug or the injection technique, but rather of the compounding procedures used to prepare the syringes containing the bevacizumab. Noncompliance with recognized standards and poor aseptic technique are the most likely causes of these outbreaks. The key to preventing these catastrophic occurrences depends on the implementation of and strict adherence to United States Pharmacopoeia Chapter 797 requirements.
  
  
  CONCLUSIONS
  Recommendations arising from a root cause analysis of infectious endophthalmitis outbreaks should focus on the procedures used by pharmacies to compound bevacizumab. Microbial contamination of bevacizumab-containing syringes prepared from the same vial of drug can be avoided by using a single vial of bevacizumab for each eye or by following strict adherence to United States Pharmacopoeia Chapter 797 requirements when compounding a single vial of bevacizumab into multiple syringes.
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
authors.forename: Serafin
authors.initials: S
authors.lastname: Gonzalez
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Rosenfeld
authors.forename: Michael W
authors.initials: MW
authors.lastname: Stewart
authors.forename: Jennifer
authors.initials: J
authors.lastname: Brown
authors.forename: Steven P
authors.initials: SP
authors.lastname: Murphy
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000737:chemistry*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000737:chemistry*; D000068258:Bevacizumab; D001766:Blindness / Q000382:microbiology / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control; D004339:Drug Compounding / Q000379:methods* / Q000592:standards; D004340:Drug Contamination / Q000517:prevention & control*; D009877:Endophthalmitis / Q000382:microbiology / Q000517:prevention & control; D015818:Eye Infections, Bacterial / Q000382:microbiology / Q000517:prevention & control; D006801:Humans; D058449:Intravitreal Injections; D004364:Pharmaceutical Preparations / Q000592:standards*; D010602:Pharmacopoeias as Topic / Q000592:standards; D014481:United States; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D004364:Pharmaceutical Preparations; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab