IOP spikes after Avastin injection attributed to compounding pharmacy
MyVisionTest
to differences in high molecular weight adducts that may plug outflow
pathways or cause an immunologic response that leads to IOP spikes, a
speaker said at American Academy of Ophthalmology.
"By no means am I saying that Avastin is doing something to the
trabecular meshwork or the eye cells," Malik Y. Kahook, MD, said
during the joint meeting of the American Academy of Ophthalmology and
Pan-American Association of Ophthalmology. "Certain compounding
techniques are affecting the components that you're getting in the
syringe, whether it's aggregation of proteins, formation of dimers and
trimers, or other components that could be as large as 20 µm."
Dr. Kahook said that he has seen 16 cases in his clinic, but has seen
reports of at least 74 additional cases in five states in the United
States. Investigation is ongoing with Lucentis (ranibizumab), but
"cases are overwhelmingly in the Avastin corner," Dr. Kahook said.
Inflammation and toxicity related to delivery of Avastin (bevacizumab)
have been suggested as potentially causing IOP spikes. However, micro
flow imaging showed significant differences in total particle number
in samples of bevacizumab drawn directly from a multidose vial, from
the vehicle and from a dose supplied by a compounding pharmacy, Dr.
Kahook said. The compounding pharmacy was selected because it supplied
doses to a Utah clinic that saw 42 postinjection IOP spikes.
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