Expert consensus for the diagnosis and treatment of sterile intraocular inflammation after intraocular drug delivery (2025)_Chinese Journal of Ocular Fundus Diseases

Authors：

 Fundus Disease ,  Group of , Ophthalmological Society , ofChinese , MedicalAssociation , FundusDisease , Committeeof , OphthalmologistBranch , ofChinese , MedicalDoctor , Association , ExpertGroup , ofExpert , Consensusfor , theDiagnosis , Treatmentof , SterileIntraocular , Inflammationafter , IntraocularDrug , Delivery(2025)

Corresponding author：

Fundus Disease, Email: dr_lixiaoxin@163.com; Group of, Email: drxuxun@sjtu.edu.cn

Keywords：

Intraocular drug delivery; Sterile intraocular inflammation; Evidence-based medicine; Diagnosis and treatment; Expert consensus

DOI：

10.3760/cma.j.cn511434-20250617-00274

Video：

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In recent years, anti-vascular endothelial growth factor (VEGF) therapy has become first line treatment for a variety of clinical conditions, including wet age related macular degeneration, macular edema secondary to retinal vein occlusion, diabetic macular edema and proliferative diabetic retinopathy. With the successive launch of new formulations such as high-dose anti-VEGF drugs and gene therapy in China, sterile intraocular inflammation (SIOI) after intraocular drug delivery has gradually come into public view and warranted attention. On the other hand, a variety of drugs that have been used in ophthalmic clinics for years, including prophylactic anti-infective drugs (such as vancomycin) and glucocorticoids (such as dexamethasone implants), have also been reported of SIOI occurrence. To avoid and alleviate the negative impact of SIOI on the visual function of the affected eyes, a systematic and standardized SIOI management system is urgently needed. For this reason, the Fundus Disease Group of Ophthalmological Society of Chinese Medical Association, Fundus Disease Committee of Ophthalmologist Branch of Chinese Medical Doctor Association, and Expert Group of Expert consensus for the diagnosis and treatment of sterile intraocular inflammation after intraocular drug delivery (2025) put forward recommended opinions on seven key clinical issues. Based on the latest evidence based medical evidence, combined with international guidelines/consensuses and the current situation of social and economic development in China, they made recommendations on aspects of SIOI, including the incidence and timing, clinical manifestations, related factors and population identification, perioperative monitoring measures, and intervention strategies and prognosis after the occurrence of SIOI, thus forming the Expert consensus for the diagnosis and treatment of sterile intraocular inflammation after intraocular drug delivery (2025). The formulation of this consensus aims to enhance the awareness and understanding of SIOI among ophthalmologists specializing in retinal diseases, provide evidence-based guidance and decision-making references for the early identification and standardized management of SIOI in clinical practice, and further improve the quality control system of intraocular injection therapy in China, thereby ensuring patient safety.

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1. Moraru AD, Danielescu C, Iorga RE. Review of guideline recommendations for optimal anti-VEGF therapy in age-related macular degeneration[J/OL]. Life (Basel), 2024, 14(10): 1220[2024-09-24]. https://pubmed.ncbi.nlm.nih.gov/39459520/. DOI: 10.3390/life14101220.
2. Galvez-Olortegui J, Bouchikh-El Jarroudi R, Silva-Ocas I, et al. Systematic review of clinical practice guidelines for the diagnosis and management of retinal vein occlusion[J]. Eye (Lond), 2024, 38(9): 1722-1733. DOI: 10.1038/s41433-024-03008-1.
3. Wong TY, Sun J, Kawasaki R, et al. Guidelines on diabetic eye care: the International Council of Ophthalmology recommendations for screening, follow-up, referral, and treatment based on resource settings[J]. Ophthalmology, 2018, 125(10): 1608-1622. DOI: 10.1016/j.ophtha.2018.04.007.
4. Beuran DI, Macovei ML, Cornăcel C, et al. Sterile endophthalmitis after intravitreal injection of triamcinolone acetonide: case report and literature review[J]. Rom J Ophthalmol, 2024, 68(1): 2-7. DOI: 10.22336/rjo.2024.02.
5. Montolío-Marzo S, Vidal-Oliver L, Montolío-Marzo E, et al. Differential diagnosis of endophthalmitis after intravitreal drug injection for age related macular degeneration: sterile vs. infectious[J]. Arch Soc Esp Oftalmol (Engl Ed), 2023, 98(7): 367-376. DOI: 10.1016/j.oftale.2023.04.014.
6. Anderson WJ, da Cruz NFS, Lima LH, et al. Mechanisms of sterile inflammation after intravitreal injection of antiangiogenic drugs: a narrative review[J]. Int J Retina Vitreous, 2021, 7(1): 37. DOI: 10.1186/s40942-021-00307-7.
7. Cox JT, Eliott D, Sobrin L. Inflammatory complications of intravitreal anti-VEGF injections[J]. J Clin Med, 2021, 10(5): 981. DOI: 10.3390/jcm10050981.
8. Banou L, Sarrafpour S, Teng CC, et al. Ocular gene therapy: an overview of viral vectors, immune responses, and future directions[J]. Yale J Biol Med, 2024, 97(4): 491-503. DOI: 10.59249/HWID7537.
9. Gautam M, Gupta R, Singh P, et al. Intracameral drug delivery: a review of agents, indications, and outcomes[J]. J Ocul Pharmacol Ther, 2023, 39(2): 102-116. DOI: 10.1089/jop.2022.0144.
10. Zeng S, Liu XL. A review of ten years of experience using dexamethasone intravitreal implants (Ozurdex) for uveitis[J]. Eur Rev Med Pharmacol Sci, 2023, 27(5): 1743-1758. DOI: 10.26355/eurrev_202303_31535.
11. Abdi F, Mohammadi SS, Falavarjani KG. Intravitreal methotrexate[J]. J Ophthalmic Vis Res, 2021, 16(4): 657-669. DOI: 10.18502/jovr.v16i4.9756.
12. 陈耀龙, 杨克虎, 王小钦, 等. 中国制订/修订临床诊疗指南的指导原则(2022版)[J]. 中华医学杂志, 2022, 102(10): 697-703. DOI: 10.3760/cma.j.cn112137-20211228-02911.Chen YL, Yang KH, Wang XQ, et al. Guiding principles for the formulation/revision of clinical diagnosis and treatment guidelines in China (2022 Edition)[J]. Natl Med J China, 2022, 102(10): 697-703. DOI: 10.3760/cma.j.cn112137-20211228-02911.
13. 孙鑫, 李玲, 李舍予, 等. 促进高质量临床实践指南快速制订与有效使用: MAGIC体系与中国行动[J]. 中国循证医学杂志, 2020, 20(1): 2-6. DOI: 10.7507/1672-2531.201909110.Sun X, Li L, Li SY, et al. Promoting the rapid creation and effective use of high-quality clinical practice guidelines: MAGIC system and China initiative[J]. Chinese Journal of Evidence-Based Medicine, 2020, 20(1): 2-6. DOI: 10.7507/1672-2531.201909110.
14. Witkin AJ, Shah AR, Engstrom RE, et al. Postoperative hemorrhagic occlusive retinal vasculitis: expanding the clinical spectrum and possible association with vancomycin[J]. Ophthalmology, 2015, 122(7): 1438-1451. DOI: 10.1016/j.ophtha.2015.03.016.
15. Witkin AJ, Chang DF, Jumper JM, et al. Vancomycin-associated hemorrhagic occlusive retinal vasculitis: clinical characteristics of 36 eyes[J]. Ophthalmology, 2017, 124(5): 583-595. DOI: 10.1016/j.ophtha.2016.11.042.
16. Schwartz SG, Relhan N, O'Brien TP, et al. A complication associated with the use of prophylactic intracameral antibiotics: hemorrhagic occlusive retinal vasculitis[J]. Ophthalmology, 2017, 124(5): 578-579. DOI: 10.1016/j.ophtha.2017.01.038.
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