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R. M. Tarantola, J. C. Folk, H. C. Boldt, III, V. B. Mahajan; Intravitreal Bevacizumab During Pregnancy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2227.
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To determine if intraocular anti-VEGF agents are safe in pregnant women.
This was a retrospective review of four women who received intravitreal bevacizumab while pregnant. Informed consent regarding the off-label use of the treatment and potential adverse effects was disclosed prior to treatment. Demographic data, ophthalmic findings, color photos, optical coherence tomography, number of injections, dose and drug used, history, and medical records after delivery were obtained from all subjects.
Four women were treated with intravitreal bevacizumab during five pregnancies. All patients had subfoveal choroidal neovascularization. The causes included presumed ocular histoplasmosis syndrome in two patients, punctuate inner choroidopathy in one patient, and sarcoid uveitis in one patient. Patients received a mean of 2.6 + 2.3 injections (range, 1-6 injections) of 1.25mg bevacizumab during pregnancy. Two patients were treated prior to pregnancy with thirteen and two injections respectively. One patient required two additional injections following pregnancy. The mean follow-up duration after the last injection was 12.5 + 3.7 months (range, 10-18 months). Snellen visual acuity improved in all four patients with a mean of 4.75 + 1.7 lines (range, 3-7 lines). At the most recent follow-up, all patients had involuted choroidal neovascularization that did not require additional treatment. There were no cases of endophthalmitis or other ocular complications related to injections. There were no cases of pregnancy complications. All patients had an uneventful pre-natal course and delivered healthy full-term infants.
The risk of anti-VEGF in pregnancy is unknown and is currently the source of great debate and concern. These women probably would have developed irreversible vision loss had they not been treated while pregnant. Based on this series, it seems reasonable to offer pregnant patients the option of intravitreal bevacizumab.
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