June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Ocular Inflammatory and Retinal Vascular Occlusive Adverse Events of Intravitreal anti-VEGF Injections: A Systematic Review and Network Meta-analysis
Author Affiliations & Notes
  • Belinda Jiao
    Universite Laval Faculte de medecine, Quebec, Quebec, Canada
  • Eunice You
    Universite Laval Faculte de medecine, Quebec, Quebec, Canada
  • Karl Chemali
    Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada
  • Mélanie Hébert
    Universite Laval Faculte de medecine, Quebec, Quebec, Canada
  • Shicheng Jin
    McGill University, Montreal, Quebec, Canada
  • Ali Dirani
    Universite Laval Faculte de medecine, Quebec, Quebec, Canada
  • Footnotes
    Commercial Relationships   Belinda Jiao, None; Eunice You, None; Karl Chemali, None; Mélanie Hébert, None; Shicheng Jin, None; Ali Dirani, Novartis Bayer (S)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 453. doi:
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      Belinda Jiao, Eunice You, Karl Chemali, Mélanie Hébert, Shicheng Jin, Ali Dirani; Ocular Inflammatory and Retinal Vascular Occlusive Adverse Events of Intravitreal anti-VEGF Injections: A Systematic Review and Network Meta-analysis. Invest. Ophthalmol. Vis. Sci. 2021;62(8):453.

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

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Abstract

Purpose : To perform a systematic review and network meta-analysis (NMA) of ocular adverse events (OAE) including endophthalmitis, inflammatory events and retinal vascular occlusive events secondary to anti-VEGFs for the treatment of neovascular age-related macular degeneration (nAMD).

Methods : A comprehensive search of Pubmed was conducted of all studies from inception until June 2020. Eligible publications included ≥ 50 patients and reported OAE of interest including endophthalmitis, uveitis, iritis, vitritis, vasculitis and ocular vascular occlusions.

Results : The search identified 7303 articles. 95 studies involving 302978 eyes were included in the systematic review and 23 comparator studies involving 261995 eyes in the NMA.

Incidence rates (IR) (total number of events n/total number of study eyes N) for endophthalmitis, inflammatory OAE and vascular occlusions were reported for each agent. Denominators for IR were based on total number of eyes across all studies that examined each complication. IR of endophthalmitis ranged from 0.27% (336/124,299) for ranibizumab to 1.2% (15/1251) for abicipar. IR of inflammatory OAE ranged from 0.9% (164/18153) for ranibizumab to 16.2% (203/1251) for abicipar. IR of vascular occlusions ranged from 0.085% (8/9460) for ranibizumab to 0.95% (8/841) for bevacizumab. Only abicipar reported retinal vasculitis at an IR of 1.8% (22/1251).

A NMA comparing the agents showed that the odds ratios (OR) (95% confidence intervals) for endophthalmitis from least to most likely with abicipar as reference were bevacizumab OR 0.097 (0.0075, 1.25), ranibizumab OR 0.13 (0.012-1.51), aflibercept OR 0.24 (0.018, 3.07), abicipar 1.00 (1.00, 1.00) and brolucizumab OR 1.12 (0.031, 40.1). For inflammatory OAE, the OR were: ranibizumab OR 0.008 (0.0011-0.59), bevacizumab 0.013 (0.0015, 1.09), aflibercept 0.096 (0.0069, 1.32), brolucizumab 0.44 (0.026, 7.24) and abicipar 1.00 (1.00, 1.00). Finally, the OR for vascular occlusive events were aflibercept OR 0.008 (0.00014, 0.55), brolucizumab OR 0.035 (0.00034-3.69), ranibizumab OR 0.044 (0.0026, 0.72), bevacizumab OR 0.15 (0.0065, 3.49) and abicipar 1.00 (1.00, 1.00).

Conclusions : The reported rates of OAE are generally low across the different anti-VEGFs but appear higher for newer agents brolucizumab and especially, abicipar. Further trials are needed to adequately assess their safety profile.

This is a 2021 ARVO Annual Meeting abstract.

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