Abstract:
The recent release of brolucizumab and the development of new antiangiogenic molecules as abicipar pegol has increased the interest towards inflammatory complications after intravitreal drug injection. Those drugs are associated to a higher rate of inflammatory adverse events compared to classic drugs. In this context it is essential to differentiate between sterile and infectious cases for a fast and effective treatment. The clinical similarities between infectious and sterile cases, the high rate of culture negative patients and the heterogeneity in the terminology used are obstacles for a correct diagnosis and report of these complications. Sterile cases appear early after the injection, before 48 h; or 20 days after in brolucizumab-related vasculitis cases. Infectious cases show up around the third day after injection and up to a week after it. A severe visual impairment, severe pain, severe hyperemia, hypopyon and a more severe intraocular inflammatory process are signs of a likely infectious origin. If the cause of the inflammation is uncertain we must follow up the patient closely or \"tap and inject\" antimicrobial agents in order to prevent the eventual complications of an infectious endophthalmitis. On the other hand, sterile endophthalmitis might be observed in mild cases or treated with steroids according to the severity of the inflammation.
摘要:
最近发布的brolucizumab和新的抗血管生成分子如abipisarpegol的开发增加了对玻璃体内药物注射后炎症并发症的兴趣。与经典药物相比,这些药物与更高的炎症不良事件发生率相关。在这种情况下,必须区分无菌和感染病例以进行快速有效的治疗。感染性病例和无菌病例之间的临床相似性,培养阴性患者的高比率和所用术语的异质性是正确诊断和报告这些并发症的障碍.无菌病例在注射后早期出现,在48小时之前;或在Brolucizumab相关血管炎病例中20天后。感染病例在注射后第三天左右出现,直到注射后一周。严重的视力障碍,剧烈疼痛,严重充血,肺功能减退和更严重的眼内炎症过程是可能的感染起源的迹象。如果炎症的原因不确定,我们必须密切随访患者或“轻拍并注射”抗菌剂,以防止感染性眼内炎的最终并发症。另一方面,无菌性眼内炎可在轻度病例中观察到,或根据炎症的严重程度用类固醇治疗.