Insight Into 102 Ocular Vascular Events During VEGF Antagonist Injections

Purpose To record ocular vascular events following injections of vascular endothelium growth factor (VEGF) antagonists. Methods Collaborative multicenter case series (41 cases), literature review (15 cases), and reports to the FDA (46 cases) of cases that had ocular vascular occlusions during anti-VEGF therapy. Results 102 cases had ocular vascular events diagnosed a median of 14 days after anti-VEGF injection. A majority of patients had preexistent risk factors for cardiovascular events and 6 patients had prior history of glaucoma. Mean visual acuity dropped by 5 lines with severe visual loss after injection to NLP (2 eyes), LP (6 eyes), and HM (2 eyes). The overall risk of ocular vascular events was 0.087%, with predilection for eyes with advanced retinal ischemia like proliferative diabetic retinopathy and ocular ischemic syndrome. Mean retinal arterial constriction after intravitreal bevacizumab in 13 eyes was 21% (standard deviation=27%) and mean venous constriction was 8% (standard deviation=30%). Conclusions The ocular vascular events during anti-VEGF therapy are rare, can lead to severe visual loss, and may be of multifactorial etiologies: vasoconstrictor effect of the drug, post-injection rise of intraocular pressure, stress of the procedure, and the natural history of underlying ocular or systemic diseases.