Complications
Development of this complication may lead to further visual loss, and patients will need to be followed closely.[118]
There is a risk of infective endophthalmitis following intravitreal injection (with vascular endothelial growth factor [VEGF] inhibitors or complement inhibitors), but this can be reduced by using appropriate aseptic techniques.[64][66][67][68][69][70][71][72] Bevacizumab that has been compounded for intravitreal injection with inadequate aseptic technique has been associated with endophthalmitis.[72]
Patients should be made aware of signs indicative of endophthalmitis, such as pain, decreased vision, light sensitivity, and increasing redness.[4]
If endophthalmitis develops, prompt referral for either vitreous tap followed by intravitreal antibiotics, or pars plana vitrectomy with injection of intravitreal antibiotics should be considered as an emergency.
There is a small risk of inflammation after intravitreal injection.[64][124] Clinical trials reported intraocular inflammation in 1% of patients receiving aflibercept and 4% of patients receiving brolucizumab.[125] Intraocular inflammation was reported in up to 5% of patients receiving pegcetacoplan in clinical trials.[64]
Management of inflammation may include a topical ophthalmic corticosteroid and systemic corticosteroid. There may be a need to check for infective endophthalmitis in severe cases.
Men taking antioxidant supplements had a small but significantly increased risk of admission to hospital for genitourinary-related causes in a clinical trial of antioxidant vitamin and mineral supplementation.[52] This was attributed to high-dose zinc intake.
Patients should be educated about this risk.
Patients in the Age-Related Eye Disease Study Group categories 2 and 3 have a 1.3% and 18% risk, respectively, over 5 years of progressing to late AMD.[52]
Patients with unilateral late AMD (Age-Related Eye Disease Study Group category 4) have a 43% chance over 5 years of developing late disease in the other eye.[52]
Patients who develop inflammation following intravitreal injection are also at risk of retinal vasculitis and retinal vascular occlusion. This has been mainly reported in post-marketing surveillance of brolucizumab.[125]
Management may include a topical ophthalmic corticosteroid and systemic corticosteroid, and consideration for change of drug used.
One cohort study of more than 400,000 people with cataract, age-related macular degeneration (AMD), or glaucoma in England found that AMD was associated with a greater risk of falls and fractures compared with matched comparators.[126]
Use of this content is subject to our disclaimer