Goldberg Roger A, Shah Chirag P, Wiegand Torsten W, Heier Jeffrey S
Retina Service, Ophthalmic Consultants of Boston, Boston, Massachusetts.
Retina Service, Ophthalmic Consultants of Boston, Boston, Massachusetts.
Am J Ophthalmol. 2014 Oct;158(4):733-737.e1. doi: 10.1016/j.ajo.2014.06.019. Epub 2014 Jun 28.
To report the presenting features and clinical outcomes of a series of patients with noninfectious inflammation after intravitreal aflibercept injection.
Noncomparative consecutive case series.
Medical records of patients who presented with noninfectious inflammation after intravitreal aflibercept injection between November 18, 2011 and June 30, 2013 were retrospectively reviewed.
A total of 20 cases of postinjection inflammation were identified in 5356 aflibercept injections. The patients presented 1-13 days after aflibercept injection (median 3 days); all noted decreased vision, while 3 of 20 (15%) had pain and 2 of 20 (10%) had conjunctival injection. One patient had a hypopyon (0.5 mm), and the average anterior chamber cell was 1.8+ (range 0 to 4+). All eyes had some degree of vitritis (average 1.8+; range 0.5+ to 4+). Patients on average had received 6 prior aflibercept injections (range 0-16). Only 1 patient-the first to present with inflammation in this series-received an intravitreal tap (culture negative) and injection of antibiotics. All patients were managed with frequent topical steroids and were followed closely for signs of improvement. All but 1 patient regained their preinjection visual acuity (average: 33 days; range: 7-73 days). Four patients were subsequently rechallenged with aflibercept, and 1 developed inflammation again after 5 additional aflibercept injections. The overall incidence of inflammation after intravitreal aflibercept injection was 20 of 5356 injections (0.37%) or 19 of 844 patients (2.25%). However, a disproportionate number of cases clustered around 1 provider (17/20, 85%; P < .001 vs all other providers) and around the 2 office locations where this physician primarily worked (16/20, 75%; P < .001 vs 5 other offices).
Noninfectious inflammation after intravitreal aflibercept injection typically presents without pain, conjunctival injection, or hypopyon, and responds to topical steroid therapy. The visual outcomes are generally favorable, though the return to baseline acuity can take many weeks.
报告一系列玻璃体内注射阿柏西普后发生非感染性炎症患者的临床表现及临床结局。
非对照连续性病例系列。
回顾性分析2011年11月18日至2013年6月30日期间玻璃体内注射阿柏西普后出现非感染性炎症患者的病历。
在5356次阿柏西普注射中，共发现20例注射后炎症病例。患者在注射阿柏西普后1 - 13天出现症状（中位时间为3天）；所有患者均视力下降，20例中有3例（15%）出现疼痛，20例中有2例（10%）出现结膜充血。1例患者有前房积脓（0.5mm），平均前房细胞数为1.8+（范围0至4+）。所有患眼均有一定程度的玻璃体炎（平均1.8+；范围0.5+至4+）。患者平均此前已接受6次阿柏西普注射（范围0 - 16次）。仅1例患者（本系列中首例出现炎症者）接受了玻璃体腔穿刺（培养阴性）并注射了抗生素。所有患者均采用频繁局部使用类固醇治疗，并密切随访观察改善迹象。除1例患者外，所有患者均恢复至注射前视力（平均：33天；范围：7 - 73天）。4例患者随后再次接受阿柏西普注射，其中1例在额外注射5次阿柏西普后再次出现炎症。玻璃体内注射阿柏西普后炎症的总体发生率为5356次注射中有20例（0.37%）或844例患者中有19例（2.25%）。然而，相当数量的病例集中在1位医生（20例中的17例，85%；与所有其他医生相比，P <.001）以及该医生主要工作的2个办公地点周围（20例中的16例，75%；与其他5个办公地点相比，P <.001）。
玻璃体内注射阿柏西普后的非感染性炎症通常无疼痛、结膜充血或前房积脓表现，对局部类固醇治疗有反应。尽管恢复至基线视力可能需要数周时间，但视觉结局总体良好。
