Incidence of retinal artery occlusion following intravitreal anti-vascular endothelial growth factor injections

Abstract

Purpose : To determine the incidence of retinal artery occlusion (RAO) and to assess associated clinical features in patients undergoing intravitreal anti-vascular endothelial growth factor (VEGF) injections.

Methods : Patients receiving intravitreal anti-VEGF injections between January 1, 2014 to December 31, 2016 at a single retina practice were identified using billing codes. Patients who developed a RAO within 90 days following an intravitreal injection were included in the study. The clinical features and patient demographics, including age, gender, systemic risk factors, reason for injections, and the anti-VEGF drug received, were reviewed.

Results : A total of 19,376 unique patients received 192,133 anti-VEGF injections during the study period. Seventeen patients developed an RAO (10 cases of central RAO and 7 cases of branch RAO) within 90 days of an injection, resulting in an incidence of 1/1140 (0.088%). There were 6 males and 11 females who had an average age of 79.6 ± 12.8 years. Prior to developing the RAO, bevacizumab was injected in 1 case, ranibizumab in 12 cases and aflibercept in 4 cases. RAO occurred in 1 out of 25,272 injections of bevacizumab (0.004%), 12 out of 78,966 injections of ranibizumab (0.015%) and 4 out of 87,895 injections of aflibercept (0.005%). Six patients underwent injections for age-related macular degeneration, 3 for diabetic macular edema, 3 for central retinal vein occlusion and 5 for branch retinal vein occlusion. The average time from injection to RAO diagnosis was 39.8 ± 15.0 days. The mean LogMAR visual acuity decreased from 0.46 (20/58 Snellen equivalent) before injection to 1.55 (20/710 Snellen equivalent) after the occurrence of RAO.

Conclusions : RAO occurred after an intravitreal anti-VEGF injection in approximately 1 in 1,140 patients. However, it is difficult to determine whether the RAO was related to the intravitreal injection procedure, injected drug, or the older age and co-morbidities of these patients.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.