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Anti-VEGF therapy generally safe to continue after postinjection inflammation
Retina. 2010;30(9):1432-1440.
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Intraocular inflammation rarely recurred with repeat intravitreal bevacizumab or intravitreal ranibizumab treatment in cases of initial sterile intraocular inflammation after bevacizumab injection, a study found.
The retrospective case series evaluated 16,166 intravitreal Avastin (bevacizumab, Genentech) injections and 3,839 intravitreal Lucentis (ranibizumab, Genentech) injections administered between 2006 and 2008. The charts of 610 patients who contacted the clinic regarding inflammation within 7 days after injection were reviewed to determine the incidence of the inflammatory reaction and if repeat injections resulted in repeat inflammatory responses.
According to the results, one case of ocular inflammation occurred after ranibizumab injection and 64 cases of inflammation occurred after bevacizumab injection. Inflammation after ranibizumab injection resolved without any steroids or antibiotics, and the patient subsequently received nine bevacizumab injections and six ranibizumab injections without repeat inflammation. Forty-eight percent of the 64 bevacizumab cases subsequently received repeat bevacizumab injections and 48% received ranibizumab injections, with three cases of recurrent inflammation with repeat bevacizumab injection and no cases of repeat inflammation with ranibizumab injection.
Two of the cases of repeat inflammation occurred in the same patient and were treated with steroids and topical antibiotics. The patient has since had five ranibizumab injections without postinjection inflammation. The second patient reporting recurrent inflammation resolved within 1 month and subsequently received nine ranibizumab injections without repeat inflammation, the study authors said.
Although the pathogenesis of postinjection inflammatory reactions after bevacizumab and ranibizumab injections is unclear, sterile intraocular inflammation is an adverse event that typically does not recur with repeat injection of either anti-VEGF, suggesting that it is generally safe to attempt to continue therapy after postinjection inflammation, the authors said.