Retinal circulatory disturbances following intracameral injection of bevacizumab for neovascular glaucoma

Comparative Retinal Vessel Size Study of Intravitreal Ranibizumab and Bevacizumab in Eyes with Neovascular Age-Related Macular Degeneration

“…Anti-VEGF treatment results in a reduction in vascular permeability and leakage via decreasing retinal vessel diameter [20] . Some clinical situations might have been exacerbated by anti-VEGF treatment, especially when ischemia is involved, as was previously reported [38][39][40][41] . Kim et al [39] have reported rapid conversion of nonischemic to severe ischemic branch retinal vein occlusion 3 weeks after intravitreal BEV injection.…”

“…Kim et al [39] have reported rapid conversion of nonischemic to severe ischemic branch retinal vein occlusion 3 weeks after intravitreal BEV injection. Yokoyama et al [41] identified widespread occlusion of both arterioles and venules at fluorescein angiography 1 month after intracamaral BEV injection in a patient with neovascular glaucoma. Taking into account the results that were obtained, the aforementioned reports speculated that anti-VEGF agents may increase ischemia, as they disrupt the retinal circulation.…”

Clinical Outcomes and Changes in Aqueous Vascular Endothelial Growth Factor Levels After Intravitreal Bevacizumab for Iris Neovascularization and Neovascular Glaucoma: A Retrospective Two-Dose Comparative Study

“…20 Since VEGF has several physiologic functions, that is, maintenance of the choriocapillaris and neuroprotection for ganglion cell survival, [21][22][23][24][25] suppressing the intraocular VEGF concentration to far under the physiologic level raises concerns about circulatory disturbances and/or neural degeneration, which may result in irreversible visual impairment in patients with advanced NVG and its responsible ischemic retinal pathologies. [26][27][28][29] If a lower dose of bevacizumab can control the VEGF concentration to a physiologic level with adequate treatment efficacy to halt neovascular activities, then it would be more appropriate and safer than the current dosage of 1.0 mg or more for treating NVG. Although many studies have reported the efficacy of IVB for managing NVG based on changes in IOP and fluorescein angiographic findings, a few studies in a MEDLINE search have quantitatively evaluated the changes in the aqueous humor concentration of VEGF resulting from IVB in a large case series of patients with advanced NVG.…”

Adverse events associated with intraocular injections of bevacizumab in eyes with neovascular glaucoma

“…There is one case report of a retinal vascular event after intracameral anti-VEGF injection. Yokoyama et al [24] presented a case of proliferative diabetic retinopathy and neovascular glaucoma that developed retinal circulatory disturbances 4 weeks after intracameral injection of bevacizumab. Other complications related to the intraocular bevacizumab injection were not remarkable, but more cases are needed to compare the risk of other complications between neovascular glaucoma and other retinal diseases.…”

“…Therefore, safety concerns, especially to ocular ischemic events, may be necessary in patients with neovascular glaucoma. In this regard, several case reports demonstrated a possible association of intraocular bevacizumab injections with ocular ischemic events [21][22][23][24][25] and cerebrovascular accidents [25] in high-risk patients with profound retinal ischemia or systemic vascular diseases. However, to our knowledge, no reports have focused on adverse events of intraocular bevacizumab injections in a series of patients with neovascular glaucoma.…”