Severe Intraocular Inflammation after Intravitreal Injection of Bevacizumab

Purpose: To report 5 cases of severe intraocular inflammation that developed after an intravitreal injection of the same lot of bevacizumab. Design: Retrospective case series. Participants: Patients treated with an intravitreal injection of bevacizumab (lot B3003B01). Methods: The clinical charts of 35 eyes of 35 consecutive patients who were treated with intravitreal injection of lot B3003B01 bevacizumab from December 18, 2008, through January 20, 2009, were reviewed. Main Outcome Measures: Incidence of intraocular inflammation, results of bacterial cultures, best-corrected visual acuity (BCVA), and endothelial cell density. Results: Five (14.3%) of the 35 cases had severe intraocular inflammation, and the inflammation had some characteristics of toxic anterior segment syndrome (TASS). Five of the 5 cases had a predominantly anterior chamber reaction, and 4 of the 5 cases were accompanied by hypopyon. Undiluted samples collected from both the aqueous and vitreous of the 5 cases were culture negative. The BCVA was 0.66 +/- 0.29 (mean +/- standard deviations) logarithm of the minimum angle resolution (logMAR) units, and the endothelial cell density was 2683.6 +/- 97.3/mm(2) before the intravitreal bevacizumab. At the final visit, the BCVA was 0.44 +/- 0.36 logMAR units, and the cell density was 2679.0 +/- 217.5/mm(2). These differences were not significant (P = 0.171 and 0.964). Conclusions: These observations indicate that an intravitreal injection of bevacizumab can induce sterile endophthalmitis that has characteristics of TASS. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2010; 117: 512-516 (C) 2010 by the American Academy of Ophthalmology.