Noninfectious endophthalmitis is more common, less harmful than infectious endophthalmitis

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Oct 26, 2009, 9:48:59 PM10/26/09

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Noninfectious endophthalmitis after anti-VEGF therapy may represent a
maturing immune response to repeated doses, according to a speaker at
the American Academy of Ophthalmology meeting.

While infectious endophthalmitis remains a pressing concern after
anti-VEGF therapy because of its potentially sight-threatening
sequelae, noninfectious endophthalmitis occurs at about a 10% greater
rate, but carries far less long-term risk.

"Unlike infectious endophthalmitis, where 30% will lose vision,
noninfectious endophthalmitis is visually nonconsequential," Jonathan
L. Prenner, MD, said at Retina Subspecialty Day before the American
Academy of Ophthalmology meeting.

Data from phase 3 studies of Lucentis (ranibizumab) indicated a
noninfectious endophthalmitis occurrence rate of about 0.19%. At
baseline, less than 1% of patients had detectable serum circulating
antibodies; at 24 months, 6.3% of patients in the MARINA study and
8.4% in the ANCHOR study started to demonstrate antibodies to
ranibizumab.

According to published literature, noninfectious endophthalmitis
occurs after about 0.38% injections of Avastin (bevacizumab), Dr.
Prenner said. Patients typically presented with symptoms at a mean 1.7
days, commonly with painless visual loss, an anterior reaction similar
to TASS and mild vitritis with a pseudo-gramulatous appearance.
However, inflammation was rare in treatment-naïve patients, Dr.
Prenner said.

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