Abstract
Purpose :
To determine if there is evidence of increased risk of cardiac and thromboembolic adverse events in central and branch retinal vein occlusion (CRVO and BRVO) patients receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF).
Methods :
BRVO and CRVO cohorts who received intravitreal anti-VEGF were compared with a control cohort of patients who had an age-related cataract or intraocular lens and no history of retinal pathology or anti-VEGF injections. Patients were matched on age, sex, race, ethnicity, body mass index, anticoagulant use, and presence hypertensive diseases, glaucoma, diabetes mellitus, and hyperlipidemia. The TriNetX database was queried for four adverse events (myocardial infarction (MI), ischemic stroke, hemorrhagic stroke, death.) Risk ratios (RR) with 95% confidence intervals (CI) were calculated for incidence of each adverse event.
Results :
After matching, the CRVO and control cohorts contained 5,476 patients (CRVO mean age 73.8 +/- 15.0 years and 48.3% female, control mean age 74.5 +/- 13.7 years and 47.8% female). The BRVO and control cohorts contained 5,559 patients (BRVO mean age 74.2 +/- 14.2 years, 53.4% female, control mean age 74.9 +/- 12.9 years, 53.6% female.) For CRVO, a significant difference in rates of death (RR 1.27; 95% CI 1.14-1.42) and MI (RR 0.78; 0.63-0.97) was identified. No significant difference in rates of ischemic stroke (RR 1.20; 1.00-1.45) or hemorrhagic stroke (RR 0.94; 0.66-1.33) was identified. For BRVO, a significant difference in rates of ischemic stroke (RR 1.22; 1.01-1.48) was identified. No significant difference in rates of death (RR 1.10; 0.98-1.24), MI (RR 0.95; 0.77-1.17), or hemorrhagic stroke (RR 1.15; 0.82-1.61) was identified.
Conclusions :
Patients with CRVO receiving intravitreal anti-VEGF had an increased risk of death and decreased risk of myocardial infarction compared to patients with an age-related cataract or intraocular lens and no history of retinal pathology or intravitreal anti-VEGF. No association was found for ischemic stroke or hemorrhagic stroke. Patients with BRVO receiving intravitreal anti-VEGF had an increased risk of ischemic stroke, but no association was found for death, MI, or hemorrhagic stroke. Further research is needed to determine if the increased risk of adverse events is related to the underlying condition of RVO or treatment with anti-VEGF agents.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.