Complications
Patients receiving photodynamic therapy need to cover all skin surface areas when in sunlight following treatment, to avoid developing a burn-like photosensitivity reaction.
It is recommended that patients with porphyria do not receive photodynamic therapy.
Development of this complication may lead to further visual loss, and patients will need to be followed closely.
There is a small risk of infective endophthalmitis following intravitreal injection, but this can be reduced by using appropriate aseptic techniques.[73][74][75][76][77] Bevacizumab that has been repackaged for intravitreal injection with inadequate aseptic technique has been associated with endophthalmitis.[57]
Patients should be made aware of signs indicative of endophthalmitis, such as pain, decreased vision, light sensitivity, and increasing redness.[23]
If endophthalmitis develops, urgent treatment with intravitreal antibiotics is required.
There is a small risk of inflammation after any intravitreal injection of anti-vascular endothelial growth factor drug.[115] Clinical trials of brolucizumab reported intraocular inflammation in 1% of patients receiving aflibercept and 4% of patients receiving brolucizumab.[116]
Management of inflammation may include topical corticosteroid and systemic corticosteroid. There may be a need to check for infective endophthalmitis in severe cases.
Intake of high doses of beta-carotene in current or recent-former smokers may increase the risk of lung cancer.[111][112]
Smokers should be advised to stop smoking. An antioxidant supplement that does not contain beta-carotene, such as the AREDS2 formulation from the Age-Related Eye Disease Study Group studies, may be considered for current or recent-former smokers.
Men taking antioxidant supplements had a small but significantly increased risk of admission to hospital for genitourinary-related causes.[34] This was attributed to high-dose zinc intake.
Patients should be educated about this risk.
Patients in the Age-Related Eye Disease Study Group categories 2 and 3 have a 1.3% and 18% risk, respectively, over 5 years of progressing to advanced AMD.[34]
Patients with unilateral advanced AMD (Age-Related Eye Disease Study Group category 4) have a 43% chance over 5 years of developing advanced disease in the other eye.[34]
Non-ocular systemic adverse events from intravitreal vascular endothelial growth factor inhibitors are reported in clinical trials, but a causative link is unproven. Caution should be exercised in patients with a history of cardiovascular and/or cerebrovascular disease, and these patients should be counselled accordingly.[113][114]
Patients who develop inflammation following intravitreal injection are also at risk of retinal vasculitis and retinal vascular occlusion. This has been mainly reported in post-marketing surveillance of brolucizumab.[116]
Management may include topical corticosteroid and systemic corticosteroid, and consideration for change of drug used.
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