Clinical Experience and Safety Profile of Intravitreal Injections in a Tertiary Hospital

Abstract

INTRODUCTION: Our aim was to evaluate the real-life experience and safety profile of intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) and/or corticosteroids for different ophthalmological conditions.
METHODS: Retrospective and observational study including all eyes submitted to IVI during the first semester of 2022. Clinical indications, the class of drug administered and the rate of therapeutic compliance were revised. Safety issues and surgical complications were also analyzed during a follow-up period between January to December 2022.
RESULTS: Three thousand four hundred and ninety-one IVI performed in 1281 eyes (of 1024 patients) were evaluated. The most common indications were macular neovascularization (MNV) (35.1%, n=450) and diabetic macular edema (DME) (34.6%, n=433), followed by retinal vein occlusion (RVO) (16.4%, n=208), proliferative diabetic retinopathy (7.3%, n=94) and inflammatory edema (4.8%, n=62). An overall therapeutic compliance rate of 90.7% (n=3491 IVI performed) was obtained: considering the missed appointments, patients with DME contributed to 43.1% of the missed appointments, followed by MNV (30.5%) and RVO (16.1%). The most common injected anti-VEGF medications were aflibercept (39.1%, n=501), followed by bevacizumab (25.8%, n=330), ranibizumab (21.8%, n=279) and brolucizumab (5.4%, n=69). Among corticosteroids, dexamethasone implant (5.9%, n=76) was the most commonly used followed by triamcinolone acetonide (1.6%, n=21) and fluocinolone implant (0.4%, n=5). Overall, the frequency of switching was 9.8%. In 40.5% cases of switch, brolucizumab was the choice for subsequent treatment, followed by aflibercept (31.7%) and ranibizumab (10.3%). During follow-up, complications occurred in 100 eyes (global rate of 2.86%): n=89 (rate of 2.53%) ocular hypertension requiring additional therapy or surgery; n=2 (rate of 0.06%) uveitis after aflibercept; n=2 (rate of 0.06%) retinal detachment, n=2 (rate of 0.06%) vasculitis after brolucizumab and n=2 (rate of 0.06%) cataract after IVI; n=1 (rate of 0.03%) endophthalmitis, n=1 (rate of 0.03%) vitreous hemorrhage and n=1 (rate of 0.03%) dexamethasone implant in the anterior chamber.
CONCLUSION: Ocular adverse events associated with IVI are relatively low and reflect the safety of these treatments. When scheduling IVI, some factors must be taken into consideration to ensure the best possible outcomes and high therapeutic compliance rates.