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C. Coriat Laurent, S. Mrejen, S. M. Tick, M. Paques, J. A. Sahel; Unusual Complication After Ranibizumab Intra Vitreous Injection: Takotsubo Syndrome. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2822.
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Ranibizumab as bevacizumab is a monoclonal antibody that inhibits VEGF (Vascular Endothelial Growth Factor). Inhibitors of angiogenesis are approuved in ophthalmology for the treatment of neo vessels in AMD.If Takotsubo syndrome has been reported in several comments at the end of systemic therapy by angiogenesis inhibitors (bevacizumab), no cases of this syndrome has been described after intra vitreous injection of anti-VEGF.We report the first case of Takotsubo syndrome after VEGF inhibitor intra vitreous injection
A patient follow with AMD (age macular degeneration) was treated by intra-vitreous injection of an inhibitor of angiogenesis (ranibizumab) as part of a complicated retinal neo vascular AMD.
After the initial single injection, the patient developed ST elevation on electrocardiogram (ECG) and elevated cardiac biomarkers. The patient underwent cardiac catheterization, which demonstrated apical ballooning and akinesis. Left ventricular function recovered within 30 days.The clinical presentation, including ECGs and findings on catheterization as well as the rapid recovery, is consistent with the diagnosis of Takotsubo cardiomyopathy.Although the cardiac event can not be formally related to the anti VEGF. Therefore, no new injection was performed and retinal neo vascularization was treated with dynamic phototherapy.
This case is the first reported case of Takotsubo syndrome following an intra vitreous injection of anti-VEGF.This complication , although unusual should be familiar to ophthalmologists and should be related to the drug family than the molecule itself (ranibizumab).
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