Purpose:

The purpose of this study is to report 10 consecutive cases of endophthalmitis after intravitreal injection of bevacizumab (avastin; roche) obtained from a single batch.

Methods:

One vial of bevacizumab (100mg/4ml) was used to take 10 sterile injections and aplied in the same moment that was taken from the batch. Bevacizumab (1.25mg/0.05ml) was injected intravitreally into 10 eyes of ten patiens to treat diabetic macular edema, choroidal neovascularization and edema following retina branch vein oclusion. All treatments were performed the same day, wich was from a single vial, being taking at the same time that the patient was injected.

Results:

All the 10 patiens show at the eye clinic between 12 and 24 hrs of being injected reporting lose vision, eight showed moderate ocular inflammation, two of them mild ocular inflammation. Cultures of vitreous from 8 where obteined and inmediatly intravitreal injection of vancomicyn, ceftazidime and dexametasone where used in 8 of them. Two of the eyes where directly underwnet to pars plana vitrectomy (ppv) because of the dense vitreous opacity. At 24 hrs all the 8 cases show vision decreased and severe ocular inflammatory reaction, all of them went to a ppv because of the bad response to the antibiotic injection. In the 10 eyes was obseved an adherent membrane in the angle (a new finding in this pathology) visual acuity returned to pre-endophthalmitis levels in four eyes, decreased in 6 eyes at one month after the injection. All of them required more than one surgical procedure. the batch was send to microbiology and was found streptococcus sanguinis (three of the intravitral sample show the same germ).

Conclusion:

Intravitreal injection of bevacizumab can cause acute endophthalmitis. most inflammation occured within 12 to 24 hrs after the intravitreous injection of the bevacizumab. Inmediatly antibiotics, steroids and a early vitrectomy with anterior chamber cleaning and remotion of an adherent membrane was effective to keep the eye globe. The visual acuity prognosis was bad in the majority of cases.

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