Sequential Sterile Intraocular Inflammation Associated With Consecutive Intravitreal Injections of Aflibercept and Ranibizumab

Ophthalmic Surg Lasers Imaging Retina. 2017 May 1;48(5):428-431. doi: 10.3928/23258160-20170428-10.


The authors report the unique response of two patients treated for cystoid macular edema (CME) secondary to central retinal vein occlusion (CRVO) who developed sequential episodes of likely sterile inflammatory responses following separate intravitreal injections of aflibercept (Eylea; Regeneron, Tarrytown, NY) and ranibizumab (Lucentis; Genentech, South San Francisco, CA) despite multiple previous uneventful injections for CME secondary to CRVO. Following the twenty-fifth aflibercept and seventh ranibizumab injection, two patients developed an acute inflammatory response, which was treated empirically with intravitreal antibiotics and topical and oral steroids (in Case 2). After an 8- to 10-week hiatus, they were switched over to ranibizumab and aflibercept, respectively, following which they developed a second episode of intraocular inflammation, treated similarly. Vitreous culture in one and aqueous culture in the other were deemed to represent contamination. Sterile intraocular inflammation, a known risk following injection with either aflibercept or ranibizumab, may develop sequentially in the same patient despite switching the drug. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:428-431.].

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Topical
  • Aged, 80 and over
  • Angiogenesis Inhibitors / administration & dosage
  • Angiogenesis Inhibitors / adverse effects
  • Anti-Inflammatory Agents / administration & dosage
  • Female
  • Humans
  • Intravitreal Injections
  • Macular Edema / diagnosis
  • Macular Edema / drug therapy*
  • Macular Edema / etiology
  • Male
  • Middle Aged
  • Prednisolone / administration & dosage
  • Prednisolone / analogs & derivatives
  • Prodrugs
  • Ranibizumab / administration & dosage
  • Ranibizumab / adverse effects*
  • Receptors, Vascular Endothelial Growth Factor / administration & dosage
  • Receptors, Vascular Endothelial Growth Factor / antagonists & inhibitors
  • Recombinant Fusion Proteins / administration & dosage
  • Recombinant Fusion Proteins / adverse effects*
  • Retinal Vein Occlusion / complications*
  • Retinal Vein Occlusion / diagnostic imaging
  • Retinal Vein Occlusion / drug therapy
  • Tomography, Optical Coherence
  • Uveitis / chemically induced*
  • Uveitis / diagnosis
  • Uveitis / drug therapy
  • Visual Acuity


  • Angiogenesis Inhibitors
  • Anti-Inflammatory Agents
  • Prodrugs
  • Recombinant Fusion Proteins
  • aflibercept
  • prednisolone acetate
  • Prednisolone
  • Receptors, Vascular Endothelial Growth Factor
  • Ranibizumab