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Brief Report
July 2017

Incidence of Presumed Silicone Oil Droplets in the Vitreous Cavity After Intravitreal Bevacizumab Injection With Insulin Syringes

Author Affiliations
  • 1Northern California Retina Vitreous Associates, Mountain View
  • 2Department of Ophthalmology, University of California, San Francisco
JAMA Ophthalmol. 2017;135(7):800-803. doi:10.1001/jamaophthalmol.2017.1815
Key Points

Question  What is the incidence of silicone oil droplets in the eye after intravitreal injection of bevacizumab preloaded in insulin syringes with compounding preparation?

Findings  In this observational study (60 patients), there was an increase in the incidence of presumed silicone oil droplets from May to November 2016 (1.73% [59 of 3402]) compared with the incidence from October 2015 to April 2016 (0.03% [1 of 3230]).

Meanings  These findings suggest that physicians should counsel their patients of the risk of floaters with intravitreal bevacizumab preloaded in insulin syringes.

Abstract

Importance  Intravitreal bevacizumab is a frequently used antivascular endothelial growth factor medication in the United States, but its off-label use is associated with risks associated with the compounding preparation.

Objective  To determine the incidence of presumed silicone oil droplets after intravitreal bevacizumab was prepared in insulin syringes by a compounding pharmacy.

Design, Setting, and Participants  A retrospective review was conducted of 60 patients who experienced intravitreal silicone oil droplets in the eye after intravitreal bevacizumab injections from a single specialist practice from October 1, 2015, to November 30, 2016. Bevacizumab, 1.25 mg/0.05 mL, was delivered in insulin syringes with a 31-gauge needle.

Main Outcomes and Measures  Small, round clear spheres in vitreous on dilated biomicroscopic retinal examination.

Results  Over a 14-month period involving 6632 intravitreal bevacizumab injections, 60 cases (35 [58%] women) of intravitreal silicone droplets were identified. Mean [SD] age of the patients was 80 [12] years; the population comprised 48 white, 9 Asian, and 3 Hispanic patients. The incidence of silicone oil droplet injections was 0.03% (1 of 3230) from October 2015 to April 2016 and 1.7% (59 of 3402) from May to November 2016 (Fisher exact test, P < .001; odds ratio [OR], 57; 95% CI, 9.8-2260). From May to November 2016, nonpriming the syringe before the intravitreal injection had a higher risk of intravitreal silicone oil droplets compared with priming the syringe (6.4% [47 of 739] vs 0.5% [12 of 2627]; Fisher exact test, P < .001; OR, 15.1; 95% CI, 7.9-33.4). Among the 60 cases, 41 patients (68%) were symptomatic, and the main symptom was floaters with spots of light. Among the patients with floaters, 36 (88%) improved over time (range, 2-8 months) despite the silicone droplets still being present on ophthalmoscopic examination.

Conclusions and Relevance  An increase in intravitreal silicone oil associated with bevacizumab prepared with insulin syringes was documented. Priming the syringe before injection was associated with a lower frequency of this complication. These findings suggest that physicians should counsel their patients on the risk of floaters with intravitreal bevacizumab preloaded in insulin syringes.

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