Avery Robert L, Castellarin Alessandro A, Dhoot Dilsher S, Pieramici Dante J, Nasir Maʼan A, Steinle Nathan C, Avery Logan P, Gordon Gabriel M
California Retina Consultants, Santa Barbara, California.
Retin Cases Brief Rep. 2019;13(2):130-134. doi: 10.1097/ICB.0000000000000570.
Despite its off-label status, intravitreal bevacizumab is the most commonly used intraocular anti-vascular endothelial growth factor agent. Regulation of compounding pharmacies has recently increased to make compounded pharmaceuticals safer. Despite these changes, a marked increase in symptomatic, large silicone oil droplets following intravitreal bevacizumab injections was noticed.
Retrospective chart review was performed. Within a single private practice, patients who were noted to have large or symptomatic silicone oil bubbles after an intravitreal injection were reviewed.
A recent, dramatic increase in the incidence of large or symptomatic silicone oil droplets was noted, with 23 cases noted in the past 5 months, compared with 1 in the previous decade. Patients frequently noted a circular floater consisting of a dark ring surrounding a bright central area immediately following an injection of intravitreal bevacizumab. All bevacizumab injections were from single-piece insulin syringes. B-scan ultrasonography produced a very characteristic reverberation pattern. No inflammation or visual acuity loss was noted because of the droplets; however, some patients were annoyed enough to consider vitrectomy.
Patients should be carefully evaluated for this possibility, and the characteristic symptom of a round floater consisting of a dark ring surrounding a bright center, and the prominent reverberation pattern on B-scan ultrasonography may help increase detection. Changes in consent forms and discussion of this possibility are indicated while investigation into the cause of this increased incidence continues, especially if one is administering bevacizumab via the one-piece insulin syringes commonly used by compound pharmacies.
尽管玻璃体腔内注射贝伐单抗属于超适应证用药，但它仍是最常用的眼内抗血管内皮生长因子药物。最近对配制药房的监管有所加强，以使配制药品更安全。尽管有这些变化，但玻璃体腔内注射贝伐单抗后出现有症状的大硅油滴的情况明显增加。
进行回顾性病历审查。在一家私人诊所内，对玻璃体腔内注射后出现大的或有症状的硅油泡的患者进行了审查。
发现近期大的或有症状的硅油滴发生率急剧上升，过去5个月记录到23例，而此前十年仅1例。患者常在玻璃体腔内注射贝伐单抗后不久，就注意到一个圆形漂浮物，由围绕明亮中心区域的暗环组成。所有贝伐单抗注射均使用一次性胰岛素注射器。B超检查产生了非常典型的混响模式。这些液滴未导致炎症或视力丧失；然而，一些患者烦恼到考虑进行玻璃体切除术。
应仔细评估患者是否有这种可能性，由围绕明亮中心的暗环组成的圆形漂浮物这一特征性症状以及B超检查上明显的混响模式可能有助于提高检测率。在对这种发病率增加的原因进行调查期间，特别是如果通过配制药房常用的一次性胰岛素注射器给予贝伐单抗时，应更改知情同意书并讨论这种可能性。
