title: Noninfectious inflammation after intravitreal injection of aflibercept: clinical characteristics and visual outcomes.
abstract: OBJECTIVE
  To report the presenting features and clinical outcomes of a series of patients with noninfectious inflammation after intravitreal aflibercept injection.
  
  
  METHODS
  Noncomparative consecutive case series.
  
  
  METHODS
  Medical records of patients who presented with noninfectious inflammation after intravitreal aflibercept injection between November 18, 2011 and June 30, 2013 were retrospectively reviewed.
  
  
  RESULTS
  A total of 20 cases of postinjection inflammation were identified in 5356 aflibercept injections. The patients presented 1-13 days after aflibercept injection (median 3 days); all noted decreased vision, while 3 of 20 (15%) had pain and 2 of 20 (10%) had conjunctival injection. One patient had a hypopyon (0.5 mm), and the average anterior chamber cell was 1.8+ (range 0 to 4+). All eyes had some degree of vitritis (average 1.8+; range 0.5+ to 4+). Patients on average had received 6 prior aflibercept injections (range 0-16). Only 1 patient-the first to present with inflammation in this series-received an intravitreal tap (culture negative) and injection of antibiotics. All patients were managed with frequent topical steroids and were followed closely for signs of improvement. All but 1 patient regained their preinjection visual acuity (average: 33 days; range: 7-73 days). Four patients were subsequently rechallenged with aflibercept, and 1 developed inflammation again after 5 additional aflibercept injections. The overall incidence of inflammation after intravitreal aflibercept injection was 20 of 5356 injections (0.37%) or 19 of 844 patients (2.25%). However, a disproportionate number of cases clustered around 1 provider (17/20, 85%; P < .001 vs all other providers) and around the 2 office locations where this physician primarily worked (16/20, 75%; P < .001 vs 5 other offices).
  
  
  CONCLUSIONS
  Noninfectious inflammation after intravitreal aflibercept injection typically presents without pain, conjunctival injection, or hypopyon, and responds to topical steroid therapy. The visual outcomes are generally favorable, though the return to baseline acuity can take many weeks.
authors.affiliation: Retina Service, Ophthalmic Consultants of Boston, Boston, Massachusetts. Electronic address: rgoldberg.eyemd@gmail.com.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Goldberg
authors.affiliation: Retina Service, Ophthalmic Consultants of Boston, Boston, Massachusetts.
authors.forename: Chirag P
authors.initials: CP
authors.lastname: Shah
authors.affiliation: Retina Service, Ophthalmic Consultants of Boston, Boston, Massachusetts.
authors.forename: Torsten W
authors.initials: TW
authors.lastname: Wiegand
authors.affiliation: Retina Service, Ophthalmic Consultants of Boston, Boston, Massachusetts.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Heier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D009877:Endophthalmitis / Q000139:chemically induced* / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D040262:Receptors, Vascular Endothelial Growth Factor / Q000009:adverse effects*; D011993:Recombinant Fusion Proteins / Q000009:adverse effects*; D012170:Retinal Vein Occlusion / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology*; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D005938:Glucocorticoids; D011993:Recombinant Fusion Proteins; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor