Published In
Ophthalmology Science
Document Type
Article
Publication Date
10-2022
Subjects
Aflibercept Syringes -- Research, Vision Loss
Abstract
Purpose
To describe cases of significant vision loss after intravitreal aflibercept administration using prefilled syringes (PFS) and to study the relationships among syringe design, injection speed, and injection force.
Design
Retrospective case series and experimental study.
Participants
Twelve patients who received intravitreal aflibercept via PFS.
Methods
All retina specialists (n = 13) at Oregon Health & Science University and the Veterans Affairs Portland Medical Center were queried in December 2020 to report episodes of significant vision loss after aflibercept PFS use. Chart review was completed for all affected patients. Using a commercially available force measuring system, injection force was measured for aflibercept PFS, ranibizumab PFS, and a tuberculin syringe at various injection speeds.
Main Outcome Measures
Number of significant vision loss episodes after aflibercept PFS use and average injection force (Newtons) at various injection speeds across different syringes.
Results
Ten specialists (76.9%) reported a perceived increase in vision loss after injection with aflibercept PFS. Sixteen events of light perception or worse vision were reported immediate after aflibercept PFS use. Chart review was available for 12 of these events. The indication for aflibercept was exudative age-related macular degeneration (n = 8), diabetic macular edema (n = 3), and central serous chorioretinopathy (n = 1). The median age of affected patients was 71 years (range, 49–94 years). Two patients were being treated for glaucoma (n = 1) or ocular hypertension (n = 1); 1 patient was a glaucoma suspect. Anterior chamber paracentesis was performed in 4 patients to normalize intraocular pressure (IOP) promptly. Laboratory experiments demonstrated that higher injection speeds were associated with higher injection forces for all syringe types. Injection forces were consistently greater with aflibercept PFS than with the ranibizumab PFS or tuberculin syringe (P < 0.0001).
Conclusions
Retina specialists at our institutions have noted numerous cases of severe transient vision loss with aflibercept PFS use. The average injection force may be greater with the aflibercept PFS when compared with other intravitreal anti–vascular endothelial growth factor (VEGF) options. Additional clinical studies are needed to understand better how syringe design and fluid dynamics may contribute to vision loss after injection.
Rights
Copyright (c) 2022 The Authors
This work is licensed under a Creative Commons Attribution 4.0 International License.
Locate the Document
DOI
10.1016/j.xops.2022.100115
Persistent Identifier
https://archives.pdx.edu/ds/psu/38727
Citation Details
Lee, D. J., Scruggs, B. A., Sánchez, E., Thomas, M., & Faridi, A. (2022). Transient Vision Loss Associated with Prefilled Aflibercept Syringes: A Case Series and Analysis of Injection Force. Ophthalmology Science, 2(2), 100115.