Sir,
There is current paucity of good current real world data on the incidence of serious complications associated with intravitreal therapy in age-related macular degeneration (ARMD). We aim to address this fact.
Report
ARMD is the leading cause of blindness in the developed world.1 The current treatment in this period involved intravitreal therapy in the form of anti-VEGF (vascular endothelial growth factor) injections. Over this time period ranbizumab was usually injected on a monthly basis in accordance with National Institute of Clinical Excellence (NICE) guidance.2
Owing to the large volume of injections performed, the monitoring of safety outcomes can be difficult. We carried out retrospective analysis on all patients attending the intravitreal service over a 5-year period. All patients with any serious complication were identified by highlighting those who have been seen in both the injection suite and in the vitreoretinal service.
In all, 4742 patients received a total of 42 513 injections in the 5-year period from August 2008 to February 2014 and were all included in this audit. Of those, 307 patients had a joint vitreoretinal appointment and an appointment in the intravitreal suite. The incidence of complication per patient for endophthalmitis was 0.04%, retinal tear 0.014%, retinal detachment 0.002%, vitreous haemorrhage (defined as significant enough to require ultrasonography) 0.009%, and lens touch 0.005%. Subgroup assessment did not reveal any correlation between the experience of the injector and complication. Optical coherence tomography (OCT) was reviewed for all patients who suffered retinal tears, detachment and vitreous haemorrhages. There was no abnormal vitreous adhesion or traction seen in this small subgroup of patients.
Intravitreal therapy is a perceived safe outpatient procedure, with nearly 400 000/year performed in the UK. The incidence of endophthalmitis, retinal tear, detachment, vitreous haemorrhage and lens touch is small. Figures from our service provide the physician with more data to enable a more detailed and frank consent to take place. The results also remain the benchmark in our service in order that we do not sacrifice safety for volume.
References
Attebo K, Mitchell P, Smith W . Visual acuity and the causes of visual loss in Australia: the Blue Mountains Eye Study. Ophthalmology 1996; 103 (3): 357–364.
National Institute for Health and Care Excellence. Ranibizumab and pegaptanib for the treatment of age-related macular degeneration. NICE technology appraisal guidance 155. August 2008. Available at: http://www.nice.org.uk/guidance/ta155.
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Severn, P., Hamilton, R. The incidence of serious complications associated with intravitreal therapy in a quaternary ARMD service (2008–2014). Eye 29, 150 (2015). https://doi.org/10.1038/eye.2014.231
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DOI: https://doi.org/10.1038/eye.2014.231