Anterior Segment Complications Following Intravitreal Injection

Abstract

Intravitreal injections (IVI s) have gained increased popularity in the past decades and are used to treat a multitude of ailments. In 2010, the total number of IVI s surpassed the number of cataract surgeries performed, making it the most common procedure in ophthalmology. As the number of injections increases, so does the number of injected-related complications. While complications in the posterior segment, such as retinal detachment or endophthalmitis, are detrimental to visual function and have therefore been well documented, IVI s can also lead to complications in the anterior segment. These include hyphema, inflammation of the sterile anterior segment (incidence rate of 0.05 to 1.1% depending on the drug), implant migration with corneal decompensation (incidence rate of 0.43%), iatrogenic lens damage (incidence rate of 0.07%), accelerated cataract formation (up to 50% for steroids and 10.9% for anti-VEGF), and an increased complication rate during subsequent cataract surgery (up to 4% per IVI). Most of these complications occur immediately and have a good prognosis if treated correctly. However, the increased risk of complications during subsequent surgery demonstrates that IVI s can also have long-term complications, a topic that needs to be explored further in future research projects.

Zusammenfassung

Intravitreale Injektionen (IVI) haben in den letzten Jahrzehnten zunehmend an Beliebtheit gewonnen und werden zur Behandlung einer Vielzahl von Erkrankungen eingesetzt. Im Jahr 2010 hat die Gesamtzahl der IVI s die Anzahl der durchgeführten Kataraktoperationen übertroffen, wodurch sie zum häufigsten Verfahren in der Augenheilkunde wurden. Mit der zunehmenden Anzahl von Injektionen steigt auch die Anzahl der damit verbundenen Komplikationen. Während Komplikationen im hinteren Augenabschnitt, wie die Netzhautablösung oder die Endophthalmitis, katastrophal für die Sehfunktion und heute gut dokumentiert sind, können IVI s auch zu Komplikationen im vorderen Augenabschnitt führen. Dazu gehören Hyphäma, sterile Entzündung des vorderen Augenabschnitts (Inzidenzrate: 0,05% – 1,1% je nach Medikament), Implantatmigration mit Hornhautdekompensation (Inzidenzrate: 0,43%), iatrogene Linsenschäden (Inzidenzrate: 0,07%), beschleunigte Kataraktbildung (bis zu 50% für Steroide und 10,9% für Anti-VEGF) und erhöhte Komplikationsrate während späterer Kataraktoperationen (bis zu 4% pro IVI). Die meisten dieser Komplikationen treten sofort auf und haben eine gute Prognose, wenn sie richtig behandelt werden. Die erhöhte Komplikationsrate während späterer Operationen zeigt jedoch, dass IVI s auch langfristige Komplikationen verursachen können, ein Thema, das in späteren Forschungsprojekten weiter erkundet werden sollte.

Keywords

intravitreal injection - anti-VEGF - cataract - complication - intraocular inflammation - vitreous

Schlüsselwörter

Glaskörper - intravitreale Injektion - Anti-VEGF - Katarakt - Komplikation - intraokulare Entzündungen

Publication History

Received: 29 April 2024

Accepted: 18 June 2024

Article published online:
15 August 2024

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