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M. Weiss, D. B. Roth, J. L. Prenner; The Incidence of Systemic Adverse Events in Patients Treated With Intravitreal Bevacizumab (Avastin). Invest. Ophthalmol. Vis. Sci. 2007;48(13):4939.
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The use of off-label intravitreal bevacizumab (Avastin) has been reported for treatment of exudative macular degeneration, diabetic retinopathy, and retinal venous occlusive disease. Although the systemic side effects of intravenous bevacizumab are well documented, less is known regarding the systemic adverse events in patients receiving intravitreal bevacizumab. We report the incidence of systemic adverse events in patients treated with intravitreal bevacizumab.
A retrospective, consecutive chart review of all patients receiving intravitreal bevacizumab from August 1, 2005 until July 1, 2006 in a university affiliated group retina practice was performed. Report of any change in medical history was noted. Physicians were queried as to the identification of any patient experiencing uncontrolled systemic hypertension, gastrointestinal bleeding, cerebrovascular accident, or other cardiovascular decompensation.
492 patients receiving 1010 injections of intravitreal bevacizumab were identified. Three patients (0.6%) experienced a severe elevation in their blood pressure, one patient (0.2%) developed a cerebrovascular accident, one patient (0.2%) developed a myocardial infarction, one patient (0.2%) developed a severe gastrointestinal bleed leading to hypotension, myocardial ischemia and death, and one patient (0.2%) developed ischemic colitis with resultant gastrointestinal bleeding and anemia. Data from formal questionnaires of patients directed at systemic medical history in order to obtain more complete information will be presented.
Intravitreal bevacizumab seems to have a low incidence of systemic adverse events, however, under reporting of systemic adverse events based on ophthalmic chart review is probable. Outside of an organized clinical trial, systemic medical information is often overlooked. Direct questioning of patients is necessary in order to obtain more complete data.
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