Noninfectious intraocular inflammation with hypopyon after intravitreal aflibercept 8 mg injection for neovascular age-related macular degeneration: a case report

Herein, we report a case of noninfectious intraocular inflammation (IOI) with hypopyon after an intravitreal aflibercept 8 mg injection for neovascular age-related macular degeneration. An 87-year-old Japanese man with neovascular age-related macular degeneration in the right eye was switched from intravitreal aflibercept 2 mg to aflibercept 8 mg to extend the treatment interval. Three days after the third aflibercept 8 mg injection, the patient presented with decreased vision without ocular pain. Slit-lamp examination revealed mild conjunctival injection and anterior chamber cells. Despite treatment with topical corticosteroids, the inflammation worsened the following day, with increased anterior chamber cells accompanied by a highly mobile hypopyon that shifted with head position. Smear microscopy of the aqueous humor showed neutrophils without detectable bacteria; the bacterial and fungal cultures were negative. Given the mild conjunctival injection, absence of ocular pain, and negative microbiological findings, noninfectious IOI was considered. The hypopyon rapidly resolved after a subconjunctival betamethasone injection on day 5. On day 8, vitritis and vitreous haze were observed and sub-Tenon triamcinolone acetonide was administered. By day 44, the best-corrected visual acuity had recovered to 20/20 and all inflammatory findings had completely resolved. Noninfectious IOI with hypopyon may occur after an intravitreal aflibercept 8 mg injection. Even when hypopyon is present after an anti-vascular endothelial growth factor injection, noninfectious IOI should be included as a differential diagnosis in addition to infectious IOI.