Insight into 144 patients with ocular vascular events during VEGF antagonist injections

Abstract

Aim

To record ocular vascular events following injections of vascular endothelium growth factor (VEGF) antagonists.

Methods

Collaborative multicenter case series (48 cases), literature reviews (32 cases), and reports to the FDA (64 cases) of patients that had vascular occlusions during anti-VEGF therapy were collected and analyzed.

Results

A total of 144 cases of ocular vascular events were identified, with these diagnosed a median of 15 days after anti-VEGF injection. The majority of patients had pre-existing risk factors for cardiovascular events and nine patients had a prior history of glaucoma. Mean visual acuity dropped by 6.4 lines with severe visual loss after injection to NLP (five eyes), LP (six eyes), and HM (two eyes). The overall risk of ocular vascular events following a VEGF antagonist injection was 0.108% in the general population and 2.61% in the diabetic population. Mean retinal arterial constriction after intravitreal bevacizumab in 13 eyes was 21% (standard deviation = 27%), and mean retinal venous constriction was 8% (standard deviation = 30%).

Conclusion

Ocular vascular events are rare during anti-VEGF therapy, but can lead to severe visual loss and may be caused by a number of factors including the vasoconstrictor effect of the drug, a post-injection rise of intraocular pressure, patient stress as a result of the procedure, and the patient’s natural history of underlying ocular or systemic diseases. The diabetic population appears to have a tendency towards ocular vascular occlusions.

Keywords:

• Bevacizumab
• retinal artery occlusion
• retinal vein occlusion
• retinal capillary occlusion
• ranibizumab

Acknowledgments

The Collaborative Anti-VEGF Ocular Vascular Complications Group: K Bailey Freund, Ninel Z Gregori, Nikolaus Feucht, Alay Banker, Therese von Hanno, Claudio Furino, Sabine Aisenbrey, Wael Soliman, Rong-Kung Tsai, Hamid Hosseini, Eric Chen, Hee-Seung Chin, Jane Y Huang, Ali A Bodla, Ozgur Artunay, Vladimir Poposki, Daniel Vilaplana, Michael Larsen, M Tariq Bhatti, Hana A Mansour, Ihab Saab, Hasan Shahine, Zohar Yehoshua, Kara Dellatorre, Shree Kurup.

The authors acknowledge the contribution of Professor FT Fraunfelder who supplied the data from the National Registry of Drug-Induced Ocular Side Effects.

Disclosure

The authors have no financial interests in any product mentioned in the manuscript.