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Incidence of Charles Bonnet syndrome after intravitreal bevacizumab injection in neovascular age‐related macular degeneration

observed after the intravitreal injection was completed, but before the eye speculum was removed. The foreign bodies were flat, transparent, purple in colour and with varying shape and a maximum size of 1 · 0.5 mm (Fig. 1A). The foreign bodies were removed from the limbus area and inferior fornix using a cotton tip (Fig. 1A). After removal of the particles, the procedure was completed with removal of the eye speculum and surgical drape, without further complications. No postinjection discomfort was reported. The plastic foreign bodies, probably originated from the surface of plastic part of the filter-needle, were small, and superficial defects were found (Fig. 1B). These defects might have been caused by the manual attachment and removal of syringe from the filter-needle during preparation of the 0.05 ml ranibizumab. The particles may have been transferred to the ocular surface by sticking to the sterile surgical gloves. This is not the first time that plastic particles have been reported to shed from syringes (Cant et al. 1988) and silicone oil microdroplets originating from syringes have been reported intraocularly after anti-VEGF treatment (Kocabora et al. 2010). If the particles had not been removed they had most likely caused foreign body sensation and might have lead to infection or corneal epithelial damage. We suggest that care should be taken to observe for potential foreign bodies even though the intravitreal injection is given under sterile condition, and patients with continuous ocular discomfort after intravitreal injections should be evaluated for possible foreign bodies.