Cluster endophthalmitis following multiple intravitreal bevacizumab injections from a single use vial.
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Date
2016-09
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Abstract
The risk of endophthalmitis is always a concern when an
intraocular procedure is performed. Intravitreal injection is a
frequently used method for therapeutic management of many
diseases, affecting the posterior segment of the eye. Hence,
it is important to assess the risk of complications, especially
endophthalmitis. Most studies conducted concentrate on risk
assessment from single use from single drug vial. The present
article reports the occurrence of cluster endophthalmitis
following multiple intravitreal bevacizumab injections from
a single vial. Intravitreal injection of bevacizumab was
administered to eight eyes of eight patients. Administered dose
was prepared from single 4-ml vial of bevacizumab and was
injected in the eye, after patient preparation and under aseptic
conditions. The procedure was repeated for the remaining
patients, thereby imparting multiple pricks in the same vial.
Four of the eight patients reported to the hospital on the 3rd day
after injection with complaints of pain, watering, and diminution
of vision. Two patients reported the following day with similar
complaints. Two patients who did not report by the 4th day were
contacted and recalled for an examination. All the patients were
thoroughly examined using slit lamp biomicroscopy and indirect
ophthalmoscopy. Six out of eight were clinically diagnosed
to have endophthalmitis and were administered intravitreal
antibiotics. The present report highlights possibility of microbial
contamination of the drug vial or during compounding process.
However, from the present incident, we are encouraged to stay
vigilant and wary of contamination.
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Keywords
Bevacizu mab, cluster endophthalmitis, alternate protocol Herein we
Citation
Khan Perwez, Khan Lubna, Mondal Prosenjit. Cluster endophthalmitis following multiple intravitreal bevacizumab injections from a single use vial. Indian Journal of Ophthalmology. 2016 Sept; 64(9): 694-696.