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C. R. Boscher, P. Verdy, K. Bernard, K. Perlemuter, F. Becquet, J. Le Rouic, D. Ducournau, S. Dumas, P. Salvetti; Neovascular AMD, Hypertension and Potential Cardiovascular Risks With Intravitreal Anti VEGF Intravitreal Injection. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3359.
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Signs of hypertensive retinopathy have recently been reevaluated and correlated to microcerebral infarcts on MRI, risk of stroke and congestive heart failure. The purpose of this study was 1) to evaluate association between neovascular AMD and signs of hypertensive retinopathy on digitized angiography 2) to evaluate its impact on hypertension diagnosis and treatment 3) to evaluate clinical setting up and cardiovascular (CV) complications of anti VEGF intravitreal injections.
Multicenter retrospective analysis. Masked observers reviewed independantly digitized angiographies and CV examination charts looking for 1) signs of chronic (generalized or focal arteriolar narrowing, arteriovenous nicking), or acute (exsudative signs, hemorrhages, cotton wool spots, papilledema) hypertensive retinopathy and 2) results of cardiovascular (re)examination and/or 24 hours blood pressure ambulatory monitoring, prior to intravitreal anti VEGF injection.
The charts of 380 patients, mean age 74 (range 60 - 98) presenting neovascular AMD were included. Hypertension was known and treated at baseline in 179/380 (47%) patients. Signs of chronic hypertensive retinopathy were found in 100/380 (26.3%) cases. Hypertension was newly diagnosed in 9/100 patients (9%) at CV preoperative (re)evaluation. Treatment of hypertension was modified in 41 % of patients with signs of chronic hypertensive retinopathy. No hypertension was found in 20% of patients with signs of chronic hypertensive retinopathy. No signs of acute hypertensive retinopathy were found in any preoperative angiogram. Adverse CV events (hypertension, stroke, myocardial infarction, thromboembolic complications) after antiVEGF intravitreal injection (bevacizumab or ranicizumab) did not occur in any patient during follow up (2-13 months).
Based on results of previously published studies (Marina, Anchor, Pier), and absence of CV complications in our study, screening for associated hypertensive retinopathy in cases of AMD might be useful to prevent CV complications before intravitreal anti VEGF injection, and to adjust anti hypertensive therapy. Signs of hypertensive retinopathy can be present without hypertension, and are likely to preceed it, as previously reported.
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