**4.5 Side effects of intravitreal injection of anti VEGFs**

Endophthalmitis, intraocular inflammation (IOI), rhegmatogenous retinal detachment, intraocular pressure elevation, and ocular hemorrhage have been reported as complications of intravitreal anti-VEGF injections [171]. There are reports of ocular inflammatory events with Brolucizumab intravitreal injection [172, 173]. Recently, occlusive retinal vasculitis has been reported with the use of Brolucizumab. For this reason, the use of Brolucizumab has been discontinued. Furthermore, the experience with Brolucizumab has increased the surveillance by an ophthalmologist of drug-related IOI.

Intraocular silicone oil droplets and protein aggregates have also been reported with intravitreal anti-VEGF injections [174]. Several systemic adverse events of anti VEGFs have been reported in different studies, including systemic hypertension, cerebrovascular accidents, heart attacks, and death [175, 176].

About 40–60% of eyes that receive anti-VEGF injections show an insufficient response with recurrent and persistent macular edema, even after repeated injections [177, 178].
