Abstract
Intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents is a commonly used therapy for numerous retinal diseases. The most commonly used of these medications are bevacizumab, ranibizumab, aflibercept, and brolucizumab. However, intravitreal administration of these agents is also associated with several inflammatory and non-inflammatory adverse events. The three inflammatory adverse events are sterile intraocular inflammation, brolucizumab-associated retinal vasculitis, and post-injection endophthalmitis. This narrative review summarizes the current literature regarding these conditions, including their epidemiology, presentation, management, outcomes, and pathogenesis. The inflammatory adverse events also share a number of overlapping features, which can make them difficult to discern from one another in a clinical context. This review discusses certain distinguishing features of these conditions that may aid providers in discerning between them and establishing the correct diagnosis.
Highlights
Intravitreal administration of anti-vascular endothelial growth factoragents is the mainstay of treatment for multiple retinal diseases, including neovascular age-related macular degeneration (AMD), diabetic macular edema, and macular edema from retinal vein occlusions
In cases where only signs of sterile intraocular inflammation (SII) are present, close followup is recommended, and serial fluorescein angiography (FA) with peripheral sweeps should be considered to assess for evidence of subtle vasculitis or retinal occlusive events [62]
SII, brolucizumab-associated retinal vasculitis (BARV), and infectious endophthalmitis are uncommon adverse events associated with intravitreal anti-VEGF administration
Summary
Intravitreal administration of anti-vascular endothelial growth factor (anti-VEGF). agents is the mainstay of treatment for multiple retinal diseases, including neovascular age-related macular degeneration (AMD), diabetic macular edema, and macular edema from retinal vein occlusions. There are several anti-VEGF agents on the market, including bevacizumab, ranibizumab, aflibercept, and brolucizumab. These medications are biologic drugs that inhibit the VEGF family of proteins, which are key to angiogenesis and vascular permeability. The inflammatory complications of intravitreal anti-VEGF injection are sterile intraocular inflammation (SII), brolucizumab-associated retinal vasculitis (BARV), and infectious endophthalmitis. There are subtle differences that may aid in making the correct diagnosis This is key given the potential for devastating outcomes if infectious endophthalmitis or BARV is not treated promptly, aggressively, and with an appropriate regimen. The remainder of this review is dedicated to summarizing the inflammatory complications associated with antiVEGF therapy, including presentation, treatment, outcomes, and means for establishing the diagnosis
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