Complications of Subspecialty Ophthalmic Care: Systemic Complications from the Intravitreal Administration of Agents that Target the Vascular Endothelial Growth Factor Pathway

Abstract

The treatment of neovascular age-related macular degeneration (AMD) and other pathologic ocular conditions that overexpress the vascular endothelial growth factor (VEGF) has been revolutionized in the last decade by the introduction of intravitreal agents that target the VEGF pathway. Since treatment trials are designed primarily to assess the prevention of vision loss caused by ocular conditions, they are inadequate for detecting rare, but potentially serious, systemic side effects. The aim of this article is to present what the ophthalmologist needs to know about systemic complications from anti-VEGF therapy and review the likelihood that these side effects occur in the context of small, but often-repeated, intravitreal doses of these potent biological medications. Preferred practice patterns need to be developed that weigh the ability of these medications to mitigate potentially blinding conditions, while at the same time minimizing the risk of adverse outcomes in specific patient populations that possess multiple and often interrelated medical comorbidities.

• Angiogenesis
• choroidal neovascularization
• intravitreal injection
• systemic side effects
• vascular endothelial growth factor

ACKNOWLEDGMENTS

The authors thank Louise Collins and Chris Nims (Howe Library, Massachusetts Eye and Ear Infirmary) for research support.