Sir,
It was interesting reading the guest editorial and the special editorial in the July issue of IJO.[1]
I would like to point out that a pack of Lucentis includes 5 μ needle filter in spite of the fact that it contains a single dose. This is not provided with bevacizumab.
Five-micron filter provided with Lucentis will not allow administration of larger particles. Large particles are known to be formed with protein containing products such as bevacizumab.[2] Such particles are known to induce inflammation and sterile endophthalmitis.[3]
The use of 5 μ needle filter will probably help in avoiding sterile endophthalmitis (culture negative) which are also seen in a cluster, even when multiple doses are removed from the same vial in one sitting with due precautions.[34]
Generally, bevacizumab is not known to be contaminated after multiple punctures, which has been demonstrated earlier by research.[5] However, if desired, potential contamination can also be eliminated using multidose vial adaptors as demonstrated by French investigators.[6] They used multidose vial adaptor having two distinct air and fluid channels. Air channel contains 0.45 μ air filter to prevent entry of microorganisms in a multidose vial and fluid channel containing 5 μ fluid filter to avoid withdrawal of large size particles.
Can this be recommended to take advantage of existing knowledge to provide affordable care to needy patients?
This is more pertinent now as we have more than one manufacturer of bevacizumab in our country.
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Conflicts of interest
There are no conflicts of interest.
1. Kumar A, Ravani R. Using intravitreal bevacizumab (Avastin ®) – Indian Scenario Indian J Ophthalmol. 2017;65:545–8
2. Kahook MY, Liu L, Ruzycki P, Mandava N, Carpenter JF, Petrash JM, et al High-molecular-weight aggregates in repackaged bevacizumab Retina. 2010;30:887–92
3. Fielden M, Nelson B, Kherani A. Acute intraocular inflammation following intravitreal injection of bevacizumab – A large cluster of cases Acta Ophthalmol. 2011;89:e664–5
4. Entezari M, Ramezani A, Ahmadieh H, Ghasemi H. Batch-related sterile endophthalmitis following intravitreal injection of bevacizumab Indian J Ophthalmol. 2014;62:468–71
5. Das T, Volety S, Ahsan SM, Thakur AK, Sharma S, Padhi TR, et al Safety, sterility and stability of direct-from-vial multiple dosing intravitreal injection of bevacizumab Clin Exp Ophthalmol. 2015;43:466–73
6. Le Rouic JF, Breger D, Peronnet P, Hermouet-Leclair E, Alphandari A, Pousset-Decré C, et al Extemporaneous withdrawal with a mini-spike filter: A low infection risk technique for drawing up bevacizumab for intravitreal injection J Fr Ophtalmol. 2016;39:415–20
