Ocular Complications of Intravitreal Avastin: a Report from Tobruk Medi-cal Center

Abstract

A retrospective statistical study was done at the ophthalmology department of Tobruk Medical Center on all the patients who received intravitreal medication with Avastin (anti-VEGF (anti-vascular endothelial growth factor)) in the period between August 1st and December 31st, 2018. It is aimed to report the complications of the intravitreal injection (IVI) and how they were managed. Out of the 56 recorded patients, there were 32 (51.9 %) females, all the patients received multiple intravitreal injections, with a total number of 131 injections. The average age of the patients was 56.5 years (ranged from 40-70 years). The most common complications after intravitreal injection were subconjunctival hemorrhage (19%), discomfort/pain (13.7%), blurring of vision (6 %), leaking at injection site (4.6%), floaters (3%), and increase intraocular pressure (IOP) in (13.7%). Six cases out of the eighteen that had high IOP received Diamox (Acetazolamide) Tab. 250 mg one-two hours before the time of injection which did not prevent the post-injection spike of IOP and that was statistically not significant (P=0.09). Thirteen eyes (10 %) developed sudden loss of vision due to sudden increase in IOP immediately after the injection, and all the cases of the high IOP were managed by anterior chamber paracentesis and the vision also improved. Endophthalmitis was recorded in only one case (0.8%), at the third-day post intraocular Avastin injection, the causative microorganism was unknown and treated with intravitreal antibiotics (vancomycin) along with topical and systemic antibiotics and steroids, but the patient did not recover until pars plana vitrectomy was done to him, and the patient recovered his preoperative vision. The patients who had glaucoma or rubeosis iridis suffered significantly (P = 0.01) from an increase in IOP levels (digitally measured) after injection with Avastin, while most other patients who didn't have both pathologies did not suffer from an increase in IOP. It can be concluded that despite having a dramatic effect on the quality of life by improving the central vision, Anti-VEGF can cause serious complications that could be prevented by early diagnosis and treatment