Complications of Intravitreal Injections: 2022

Abstract and Introduction

Abstract

Purpose of Review: This review highlights the complications of both intravitreal injection procedure as well as different intravitreal medications including antivascular endothelial growth factors, antibiotics, antivirals, antifungals, methotrexate, and steroids. Techniques for reducing rates of endophthalmitis will also be discussed.

Recent Findings: Intravitreal vancomycin can cause hemorrhagic occlusive retinal vasculitis resulting in severe vision loss. Intravitreal brolucizumab is associated with intraocular inflammation and retinal vasculitis resulting in significant vision loss. Face mask use by both patient and physician is not associated with increased risk of endophthalmitis and may decrease culture positive endophthalmitis.

Summary: Intravitreal injections continue to be one of the most commonly performed procedures by ophthalmologists. Although the injections are generally well tolerated, sight-threatening complications can occur including endophthalmitis, retinal detachment, and/or retinal vasculitis. Adverse events associated with specific medications are outlined below. Several safety measures have been shown to reduce rates of endophthalmitis, the most concerning complication of this procedure.

Introduction

Intravitreal injections were first introduced as an ophthalmic procedure in the early 1900 s when Ohm used an intravitreal air bubble to repair a retinal detachment.^[1] Today, intravitreal injections have become one of the most commonly performed procedures throughout ophthalmology clinics worldwide. This growth has been exponential, increasing from approximately 2900 injections in the year 2000 to more than 2.6 million in the year 2014.^[2] The number of injections has continued to grow, both due to expanding indications for injections, as well as a greater number of medications that include vascular growth factor (VEGF) inhibitors, antibiotics, antivirals, anti-fungals, and steroids. As millions of intravitreal injections are performed annually, this review highlights the medications commonly administered as intravitreal injections along with their respective complications, and discusses the impact of risk reduction strategies for postinjection endophthalmitis.