May 2008
Volume 49, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2008
Evaluation of Central Retinal Artery Occlusion (CRAO) After Intravitreal Injection: Comparison of Pegaptanib, Bevacizumab, and Ranibizumab
Author Affiliations & Notes
  • C. I. Bourne
    Howard University Hospital, Washington, Dist. of Columbia
  • W. Deegan
    Retina Group of Washington, Fairfax, Virginia
  • Footnotes
    Commercial Relationships  C.I. Bourne, None; W. Deegan, None.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 5564. doi:https://doi.org/
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      C. I. Bourne, W. Deegan; Evaluation of Central Retinal Artery Occlusion (CRAO) After Intravitreal Injection: Comparison of Pegaptanib, Bevacizumab, and Ranibizumab. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5564. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : To evaluate the incidence of CRAO after intravitreal injection (IVT) with pegaptanib, bevacizumab, and ranibizumab. Determine if co-morbities and social risk factors contributed to the occurrence of CRAO.

Methods: : This retrospective chart review included 67 patients from a large retinal group over 12 months, June 2006 - May 2007. Patients received a total of 287 IVT. Diagnosis of CRAO was made by dilated fundus examination. All patients diagnosed with CRAO underwent immediate intraocular paracentesis.

Results: : Of the 67 patients, 41 were females and 26 were males. Age ranged from 35 to 102 years. Ranibzumab was given to 223 of 287 (77.7%), bevacizumab to 60 of 287 (20.9%), and pegaptanib to 4 of 287 (13.9%). Sixty three patients (94.3%) were receiving treatment for neovascular membranes (NVM) secondary to age related macular degeneration (AMD) and 4 patients (5.97%) for NVM secondary to presumed ocular histoplasmosis. Co-morbities of this cohort in included hypertension (HTN) (64.2%), cardiac arrthymia/disease (23.9%), diabetes mellitus (5.97%). Social and ocular history included 11.9% using tobacco, 47.76% with pseudophakia, and 7.46% with glaucoma. CRAO occurred in a total of 6 patients; one patient having reoccurrence of CRAO. Overall, incidence was 2.44%. All of the cases of CRAO occurred in the ranibzumab group, with incidence of 3.14%, equal distribution of gender, and mean age of 82.6 years. All of the ranibzumab group were receiving treatment for NVM secondary to AMD. The 6 patients with CRAO received a total of 31 injections, an average of 5.17 IVT per person in comparison with the overall cohort average of 4.28 injections per person. In the CRAO group, 2 of the 6 (33%) had pseudophakia and 1 of 6 (16.7%) had glaucoma. Five of the 6 patients (83.33%) had HTN, 4 of 6 (66.7%) reported cardiac arrthymia/disease, and 1 of 6 (33%) used tobacco. All had intraocular pressures <21 mmHg prior to IVT. All patients had recovery of vision to +/-1 line of visual acuity prior to IVT.

Conclusions: : Patients treated with anti-VEGF IVT can develop ocular side-effects such as CRAO. It is prudent to treat visual symptoms immediately for preservation of visual function. To date, CRAO has not been listed as a major side effect of IVT anti-VEGF treatment. Our early results suggest that underlying vasculopathy may be a contributing factor. Further research should be conducted to aid ophthalmologists in identifying high-risk patients to better understand side effects of different anti-VEGF treatments.

Keywords: retina • age-related macular degeneration 
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