Insight Into 102 Ocular Vascular Events During VEGF Antagonist Injections

Abstract

Purpose: : To record ocular vascular events following injections of vascular endothelium growth factor (VEGF) antagonists.

Methods: : Collaborative multicenter case series (41 cases), literature review (15 cases), and reports to the FDA (46 cases) of cases that had ocular vascular occlusions during anti-VEGF therapy.

Results: : 102 cases had ocular vascular events diagnosed a median of 14 days after anti-VEGF injection. A majority of patients had preexistent risk factors for cardiovascular events and 6 patients had prior history of glaucoma. Mean visual acuity dropped by 5 lines with severe visual loss after injection to NLP (2 eyes), LP (6 eyes), and HM (2 eyes). The overall risk of ocular vascular events was 0.087%, with predilection for eyes with advanced retinal ischemia like proliferative diabetic retinopathy and ocular ischemic syndrome. Mean retinal arterial constriction after intravitreal bevacizumab in 13 eyes was 21% (standard deviation=27%) and mean venous constriction was 8% (standard deviation=30%).

Conclusions: : The ocular vascular events during anti-VEGF therapy are rare, can lead to severe visual loss, and may be of multifactorial etiologies: vasoconstrictor effect of the drug, post-injection rise of intraocular pressure, stress of the procedure, and the natural history of underlying ocular or systemic diseases.

Keywords: ischemia • injection • drug toxicity/drug effects