Mechanisms of sterile inflammation after intravitreal injection of antiangiogenic drugs: a narrative review

Table 2 Characteristics of intraocular inflammation following intravitreal anti-VEGF

	Sterile uveitis/endophthalmitis	Delayed onset retinal vasculitis
Incidence	Bevacizumab (0.05–1.1%) Ranibizumab (0.005–1.9%) Aflibercept (0.05–2.1%) Brolucizumab (4.4%)³⁴	Brolucizumab (0.002–3.3%)^a
Time of onset	1–3 days	30–53 days (range 8–137)
Clinical manifestations	Decreased visual acuity Anterior chamber inflammation Vitreous cavity inflammation	Decreased visual acuity Anterior chamber inflammation Vitreous cavity inflammation Vasculitis
Final VA	Baseline VA	Mean VA loss 38 letters 46% lose > 3 lines
Attempted management	Observation Topical steroid Oral steroid Peri-ocular steroid Vitrectomy	Topical steroid Oral steroid Peri-ocular steroid Vitrectomy
Inflammatory mechanism	TASS-like reaction	Type III/IV Hypersensitivity
Potential causative factors	Drug Protein aggregates Silicone oil Endotoxin	Auto-immune reaction to drug Protein aggregates Drug impurities

Data from references [9,10,11, 23, 34, 35]
^aRate of 15.47 per 10,00 injections for retinal vasculitis and/or retinal vascular occlusion reported in cumulative review of post marketing data performed by Novartis from October 2019 through November 20th, 2020

ISSN: 2056-9920