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Matthew Starr, Lauren A Dalvin, Jackson Abou Chehade, Gena M Damento, Maria Garcia, Saumya M Shah, Raymond Iezzi, Sophie J Bakri; Classification of strokes seen in patients receiving intravitreal anti-vascular endothelial growth factor. Invest. Ophthalmol. Vis. Sci. 2017;58(8):892.
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© ARVO (1962-2015); The Authors (2016-present)
Strokes are currently classified into ischemic, embolic, or hemorrhagic infarcts. The purpose of this study was to identify the differences, if any, in the types of strokes seen in patients receiving intravitreal anti-vascular endothelial growth factor (VEGF) versus a normal control population.
We performed a retrospective consecutive review of all patients receiving intravitreous anti-VEGF injections from 1/1/2004 and 12/31/2013. We utilized the Rochester Epidemiology Project (REP) records to identify all patients who received at least 1 anti-VEGF injection for exudative age related macular degeneration (AMD), diabetic macular edema (DME), proliferative diabetic retinopathy (PDR), and vein occlusion (VO). A 2-year of follow-up period was required for study inclusion. Two age- and sex-matched control groups were identified from the REP: one cohort from the pre-anti-VEGF era (1990-2003), and one concurrent cohort from 2004-2013. Charts were manually reviewed for demographic data, medical history, thromboembolic events, and mortality data. Regarding strokes, we collected the location, type, and age of the patient at the time of the stroke, through 12/31/2015.
There were 690 patients identified during the study period as receiving an intravitreal injection for AMD, DME, PDR, and VO. There were 419 (60.7%) females and 271 (39.3%) males with a mean age of 74.1 ± 12.0. 39 of these patients (5.7%) suffered a stroke within the two-year period after starting intravitreal injection therapy. In the era prior to anti-VEGF, 92 patients (14.0%) suffered a stroke, and in the concurrent cohort, 27 (3.2%) suffered a stroke. Of the patients in the study group, 38 had sufficient data to characterize the type of stroke, 27 (71.1%) were ischemic, 6 (15.8%) were embolic, and 5 (13.2%) were hemorrhagic. There were no differences in the types of strokes identified amongst the patients receiving intravitreal injections and those in the pre-VEGF era as well as the concurrent time period (all p values >0.05).
Some literature suggests that the mechanism of action of anti-VEGF agents may predispose patients to suffering from hemorrhagic infarcts. Our data suggests that there was no predilection to the development of hemorrhagic infarcts, or ischemic strokes, in those patients receiving intravitreal anti-VEGF compared to control populations.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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