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Abstract
Purpose
Intravitreal injection of bevacizumab (Avastin®) can lead to several intraocular complications including endophthalmitis, hemorrhage and inflammation. We present one case of acute anterior uveitis with hypopyon in an HLA-B27(+) patient following intravitreal injection of bevacizumab.
Case summary
A 40-year-old male with known central retinal vein occlusion presented with redness and decreased visual acuity in the left eye. Symptoms had developed 4 days earlier after the sixth intravitreal injection of bevacizumab in that eye. The patient had a marked anterior chamber reaction with hypopyon and posterior synechiae. Nine days after onset, similar symptoms in the left eye occurred in the uninjected right eye. Through examination and clinical manifestations, we diagnosed acute anterior uveitis associated with HLA-B27 positivity. The patient was treated with 1% prednisolone ace-tate, 0.5% moxifloxacin and 1% atropine in both eyes and all symptoms had resolved after 6 weeks.
References
1. Rosenfeld PJ, Moshfeghi AA, Puliafito CA. Optical coherence to-mography findings after an intravitreal injection of bevacizumab (avastin) for neovascular age-related macular degeneration. Ophthalmic Surg Lasers Imaging. 2005; 36:331–5.
2. Spaide RF, Laud K, Fine HF. . Intravitreal bevacizumab treat-ment of choroidal neovascularization secondary to age-related macular degeneration. Retina. 2006; 26:383–90.
3. Rabena MD, Pieramici DJ, Castellarin AA. . Intravitreal bev-acizumab (Avastin) in the treatment of macular edema secondary to branch retinal vein occlusion. Retina. 2007; 27:419–25.
4. Avery RL, Pearlman J, Pieramici DJ. . Intravitreal bev-acizumab (Avastin) in the treatment of proliferative diabetic retinopathy. Ophthalmology. 2006; 113:1695.e1–15.
5. CATT Research Group, Martin DF, Maguire MG. . Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med. 2011; 364:1897–908.
6. Stepien KE, Rosenfeld PJ, Puliafito CA. . Comparison of intra-vitreal bevacizumab followed by ranibizumab for the treatment of neovascular age-related macular degeneration. Retina. 2009; 29:1067–73.
7. Pieramici DJ, Avery RL, Castellarin AA. . Case of anterior uveitis after intravitreal injection of bevacizumab. Retina. 2006; 26:841–2.
8. Jonas JB, Spandau UH, Rensch F. . Infectious and non-infectious endophthalmitis after intravitreal bevacizumab. J Ocul Pharmacol Ther. 2007; 23:240–2.
9. Shima C, Sakaguchi H, Gomi F. . Complications in patients af-ter intravitreal injection of bevacizumab. Acta Ophthalmol. 2008; 86:372–6.
10. Marticorena J, Romano V, Gómez-Ulla F. Sterile endophthalmitis after intravitreal injections. Mediators Inflamm. 2012; 2012:928123.
11. Mamalis N, Edelhauser HF, Dawson DG. . Toxic anterior seg-ment syndrome. J Cataract Refract Surg. 2006; 32:324–33.
12. Chang JH, McCluskey PJ, Wakefield D. Acute anterior uveitis and HLA-B27. Surv Ophthalmol. 2005; 50:364–88.
13. Power WJ, Rodriguez A, Pedroza-Seres M, Foster CS. Outcomes in anterior uveitis associated with the HLA-B27 haplotype. Ophthalmology. 1998; 105:1646–51.
14. Otasevic L, Zlatanovic G, Stanojevic-Paovic A. . Helicobacter pylori: an underestimated factor in acute anterior uveitis and spon-dyloarthropathies? Ophthalmologica. 2007; 221:6–13.
15. Kim TH, Uhm WS, Inman RD. Pathogenesis of ankylosing spon-dylitis and reactive arthritis. Curr Opin Rheumatol. 2005; 17:400–5.
16. Bakri SJ, Larson TA, Edwards AO. Intraocular inflammation fol-lowing intravitreal injection of bevacizumab. Graefes Arch Clin Exp Ophthalmol. 2008; 246:779–81.
17. Johnson D, Hollands H, Hollands S, Sharma S. Incidence and characteristics of acute intraocular inflammation after intravitreal in-jection of bevacizumab: a retrospective cohort study. Can J Ophthalmol. 2010; 45:239–42.
18. Taban M, Singh RP, Chung JY. . Sterile endophthalmitis after intravitreal triamcinolone: a possible association with uveitis. Am J Ophthalmol. 2007; 144:50–4.
19. Roth DB, Chieh J, Spirn MJ. . Noninfectious endophthalmitis as-sociated with intravitreal triamcinolone injection. Arch Ophthalmol. 2003; 121:1279–82.
20. Mozayan A, Farah S. Acute anterior uveitis following intravitreal injection of bevacizumab. Ophthalmic Surg Lasers Imaging Retina. 2013; 44:25–7.
21. Bakri SJ, Snyder MR, Reid JM. . Pharmacokinetics of intra-vitreal bevacizumab (Avastin). Ophthalmology. 2007; 114:855–9.
22. Ho J, Loewenstein JI. Endophthalmitis associated with intravitreal injections. Int Ophthalmol Clin. 2007; 47:199–208.
Figure 1.
Photograph of the left eye 4 days after sixth intravitreal injection of bevacizumab. (A) Hyperemia of conjunctival vessel, anterior chamber reaction (4+ cells) and posterior synechia with hypopyon. (B, C) Cotton wool spot, and photocoagulation scar was detected. Slightly decreased clearance due to anterior chamber reaction with hypopyon.
Figure 2.
Slit-lamp photograph of the left eye at 1 week after treatment: anterior chamber reaction (1+ cells) and posterior synechia without hypopyon.
Figure 3.
Photograph of the uninjected right eye. (A) Anterior chamber reaction (3+ cells) and posterior synechia with hypopyon. (B, C) Slightly decreased clearance due to anterior chamber reaction with hypopyon.
Figure 4.
Slit-lamp photograph of the right eye at 1 week after treatment: anterior chamber reaction (1+ cells) and posterior synechia without hypopyon.
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