International Ophthalmology

, Volume 37, Issue 2, pp 325–332 | Cite as

Safety and complications of intravitreal injections performed in an Asian population in Singapore

  • Yanping Xu
  • Colin S. Tan
Original Paper


There has been a rapid rise in the use of intravitreal injections, such as anti-vascular endothelial growth factor (anti-VEGF) agents, performed over the past few years for the treatment of ocular neovascular diseases. This study aims to review the systemic and ocular adverse events among patients treated at a tertiary eye center over a period of 8 years. A retrospective review of all intravitreal injections of anti-VEGF performed over an 8-year period at a tertiary eye care center in Singapore was done. We report the frequency of systemic and ocular adverse events and compared it among the various anti-VEGF agents. A total of 14 001 intravitreal injections were performed on 2225 patients from January 1, 2007 to December 31, 2014, and this included 9992 bevacizumab (71.4 %), 3306 ranibizumab (23.6 %) and 703 aflibercept (5.0 %) injections. Systemic complications related to treatment were 26 (1.17 %) deaths (from any cause), of which 11 (0.49 %) were from fatal thromboembolic events, 7 (0.31 %) non-fatal thromboembolic events and two (0.09 %) serious non-ocular hemorrhage. Ocular complications included one (0.007 %) endophthalmitis, three (0.021 %) traumatic cataracts, and one (0.007 %) retinal detachment. Rates of death and thromboembolic events were similar among ranibizumab (lucentis), bevacizumab (avastin) and aflibercept (Eylea). The systemic and ocular complications associated with intravitreal injections among Asian patients at a tertiary eye center are relatively low and reflect the safety of the treatments.


Age-related macula degeneration Intravitreal injection Anti-vascular endothelial growth factor Choroidal neovascularization Safety 



We would like to acknowledge the doctors of the vitreo-retinal team and registrars from the National Healthcare Group Eye Institute (NHGEI), Tan Tock Seng Hospital Singapore, who assisted in the collection of the data. We would like to thank Hon Tym Wong and Rajesh Rajagopalan for their input, and Elizabeth Wong for statistical support. Dr. Colin Tan receives travel support from Bayer, Heidelberg Engineering, and Novartis. He also receives research support from National Healthcare Group Clinician Scientist Career Scheme Grant (CSCS/12005).


Dr. Xu Yanping has no financial support.


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Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  1. 1.Department of Ophthalmology, National Healthcare Group Eye InstituteTan Tock Seng HospitalSingaporeSingapore
  2. 2.Fundus Image Reading CenterNational Healthcare Group Eye InstituteSingaporeSingapore

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