Sterile Endophthalmitis After Intravitreal Injection of Bevacizumab Obtained From a Single Batch

In Brief Purpose: The purpose of this study was to report 14 consecutive cases of endophthalmitis after intravitreal injection of bevacizumab (Avastin; Roche, Basel, Switzerland) obtained from a single batch. Methods: One vial of bevacizumab (100 mg/4 mL) was divided into 20 sterile injections and kept at 4°C before use. Bevacizumab (1.25 mg/0.05 mL) was injected intravitreally into 19 eyes of 15 patients to treat macular edema or choroidal neovascularization. All treatments were performed within 1 week of the bevacizumab, which was from a single batch, being aliquotted into the 20 doses. Results: Of the 19 eyes, 14 showed moderate to severe ocular inflammation immediately after injection. Cultures of aqueous humor and vitreous from 5 eyes were negative for bacteria and fungi. Eyes with moderate inflammation received topical or systemic antibiotics and steroid treatment. Five eyes with severe inflammation underwent pars plana vitrectomy because of dense vitreous opacity. Visual acuity returned to preendophthalmitis levels in 12 eyes but had decreased in 2 eyes at 1 month after the injection. Conclusion: Intravitreal injection of bevacizumab can cause sterile endophthalmitis. Most inflammation occurred within a few days after the intravitreous injection of the bevacizumab, but treatment with antibiotics, steroids, and/or vitrectomy was effective, and the prognosis was good in most cases. The authors report 14 consecutive cases of sterile endophthalmitis after intravitreal injection of bevacizumab obtained from a single batch. Ocular pain, hyperemia, cellular infiltration, and vitreous opacity appeared a few days after the injection. Most eyes regained initial visual acuity after treatment, which included pars plana vitrectomy in some cases.