24. Intra- and postoperative side effect after intravitreal
injections of bevacizumab
Lars-Olof Hattenbach (Ludwigshafen)
Background: To date, there is much evidence that intravitreal bevacizumab may be effective in
the treatment of various neovascular disorders of the posterior segment of the eye. However,
in light of a lack of prospective randomized trials, little is known about possible side effects.
Methods: We investigated the intra- and postoperative course in 216 patients (235 eyes) who
received intravitreal injections of bevacizumab (1.25 mg) for the treatment of choroidal neovascularization,
diabetic macular edema, or retinal vein occlusion. Intravitreal injections were
administered under sterile conditions. Anterior chamber paracentesis was performed intraoperatively
whenever a significant postinjection rise in intraocular pressure occurred.
Results: Overall, we performed 464 intravitreal injections with an average of 2 injections per
eye (range 1-6 injections). Of these, 28 % required an additional aqueous tap. In one patient, we observed a transient conjunctival
ischemia at the injection site, associated with a circumscribed scleral thinning. No major ocular complications such
as intravitreal hemorrhage, retinal detachment, or endophthalmitis were observed.
Conclusions: The current findings suggest that intravitreal injections of bevacizumab may be associated with ischemia or
trophic tissue changes at the injection site. There is a reasonable likelihood that this effect may be the result of an intraoperative
elevation of intraocular pressure and pooling of bevacizumab under the conjunctiva. Furthermore, it may be speculated
that subconjunctival resorption of antiangiogenic substances carries the risk of systemic vascular complications.