After a number of reports indicating that patients were experiencing floaters after eye injection with Avastin (bevacizumab), researchers began to dive in to find out more about this phenomenon. One researcher reported that in 2016, the reports of complications such as floaters after eye injection rose significantly, according to an article in MedPage Today.

Rahul Khurana, MD, a doctor with Northern California Retina Vitreous Associates stated that the reports at his practice increased from 0.03%  to 1.73% between periods in 2015 and 2016.

These floaters after eye injection are apparently caused after Avastin is injected into the patient’s eye(s) using a preloaded insulin syringe to deliver the medication. The floaters were allegedly due to the silicone oil droplets in the syringe.

Avastin is used in an off-label fashion to treat eye conditions such as age-related macular degeneration, retinal vein occlusion, diabetic macular edema and diabetic retinopathy. Drugs that are used off-label are used to treat conditions for which they are not FDA approved. This process is legal, but sometimes unexpected consequences may occur.

Avastin is FDA approved to treat cancer by targeting the growth of blood vessels that can feed tumors. When used in the eye, Avastin prevents the further growth of abnormal blood vessels that can lead to vision loss.

Avastin and Silicone Oil

Doctors who use Avastin to treat eye-related diseases have the medication compounded by pharmacies that place the medication in pre-filled syringes typically designed to administer insulin.

It appears, however, that some of the syringes are primed with an oil that is designed to have the contents of the syringe more easily expelled when the syringes pressed, and Dr. Khurana believes this may be why patients experience floaters after eye injection with Avastin. The lubricant in the syringe may be causing the complications.

When Khurana studied 60 cases of the silicone droplets from a total of 6,632 Avastin injections, he found that about 70% of his patients were reported dealing with “floaters with spots of light.” Fortunately over a period of time, from approximately two to eight months, the majority of these patients, around 90%, reported improvement despite the silicone droplets still being present on a detailed eye exam.

As a result of his findings, Dr. Khurana decided to change the syringes his practice uses in order to deliver the Avastin injections. He stopped using the insulin syringes and began using syringes that had a luer cone design. He also ensured that the syringes did not use an oil-based lubricant in order to deliver the medication.

Dr. Khurana states that any physicians administering Avastin injections to treat eye-related diseases should provide informed consent to patients that they may experience floaters after eye injection if the physician is using preloaded insulin syringes in order to deliver the medication.

Despite Dr. Khurana’s practice having issues with the syringes, not all offices have experienced the same issues, MedPage Today notes. Another ophthalmologist, Dr. Frank Siringo of UCHealth Aurora has not had the issue and reported his thoughts by email.

“As one of the most commonly used in-office drug, compounded bevacizumab is very important. This study highlights the myriad of quality control issues that can impact our patients when we use compounded pharmaceuticals,” Dr. Siringo stated.

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