Retinal vascular events after intravitreal bevacizumab

Abstract

ABSTRACT.Purpose: To record retinal vascular events following intravitreal bevacizumab injection. Methods: Collaborative multi-centre retrospective case series. Results: Eight patients were documented to have central retinal artery occlusion (four patients), branch retinal artery occlusion, capillary occlusion, central retinal vein occlusion and branch retinal vein occlusion (one patient each) within 0-55 days (median 2 weeks) of intravitreal bevacizumab. All patients had several ocular and systemic risk factors for retinal vascular events: elevated intraocular pressure on discharge (four patients), pre-existent glaucoma (one patient), pre-existent ischaemic retinal vascular disorder (four patients), systemic hypertension (five patients), diabetes mellitus (three patients), coronary artery disease (four patients), carotid disease (three patients), smoking (two patients) and migraine (one patient). Conclusion: The retinal vascular events may be associated with the underlying ocular disease under treatment or with the underlying systemic disease, may be related to an increased intraocular pressure post-injection constraining further an already poor retinal perfusion, the vasoconstrictor effect of bevacizumab, or a combination of all three.Key words: bevacizumab -branch retinal artery occlusion -branch retinal vein occlusioncapillary occlusion -central retinal artery occlusion -central retinal vein occlusion

Cotton Wool Spots after Anti-Vascular Endothelial Growth Factor Therapy for Macular Edema Associated with Central Retinal Vein Occlusion

“…Although we know that the development of CWS is extremely rare after the injections of anti-VEGF agents for neovascular age-related macular degeneration [25], several CRVO case reports show a worsening of retinal perfusion after intravitreal injections of bevacizumab or IVR [26,27,28,29,30]. In the current study, we report 23 eyes with CRVO that exhibited the presence of CWS 1 month after an initial IVA or IVR injection.…”

Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature

“…51 Rare ocular and systemic side effects There are few reports of ocular and systemic adverse events associated with intravitreal anti-VEGF agents. Rare ocular adverse events include anterior ischemic optic neuropathy after bevacizumab injection, 52,53 retinal venous occlusions after bevacizumab injection, 54 retinal artery occlusions, 55 hemorrhagic macular infarction, 56 development or exacerbation of ocular ischemic syndrome, 57 and sixth nerve palsy following bevacizumab injection. 58 Rare systemic events include formed visual hallucinations, 59 erectile dysfunction, 60 and acute decrease in kidney function.…”

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

“…Another survey of intravitreal bevacizumab injections found five cases (0.04%) out of 12,158 injections that experienced retinal artery occlusion after injection [23]. Therefore, retinal artery occlusion is regarded as a very rare complication of the intraocular use of anti-VEGF agents.…”

“…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.…”