Classification of Strokes in Patients Receiving Intravitreal Anti-Vascular Endothelial Growth Factor

Ophthalmic Surg Lasers Imaging Retina. 2019 May 1;50(5):e140-e157. doi: 10.3928/23258160-20190503-14.

Abstract

Background and objective: The purpose of this study was to identify the differences in the types of strokes seen in patients receiving intravitreal anti-vascular endothelial growth factor (VEGF) compared with normal control populations.

Patients and methods: We performed a retrospective consecutive review of all patients receiving intravitreal anti-VEGF injections in Olmsted County, Minnesota, from January 1, 2004, to December 31, 2013, for exudative age-related macular degeneration (AMD), diabetic macular edema (DME), proliferative diabetic retinopathy (PDR), or retinal vein occlusion (RVO). A 2-year follow-up period was required for study inclusion. Three age- and sex-matched cohorts were identified.

Results: A total of 2,541 patients were examined. There were 690 patients identified during the study period as receiving an intravitreal injection for AMD, DME, PDR, or RVO. Of these patients, 38 (5.8%) suffered a stroke after starting intravitreal injection therapy. Of these strokes, 27 (71.1%) were ischemic, six (15.8%) were embolic, and five (13.2%) were hemorrhagic. There were no differences in the types of strokes identified among the patients receiving intravitreal injections between the case cohort and the control cohorts (P > .05 for all).

Conclusion: The authors' data suggest there is no predilection to the development of ischemic infarcts or hemorrhagic strokes in those patients receiving intravitreal anti-VEGF compared with control populations. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e140-e157.].

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angiogenesis Inhibitors / administration & dosage
  • Angiogenesis Inhibitors / adverse effects*
  • Aptamers, Nucleotide / administration & dosage
  • Aptamers, Nucleotide / adverse effects
  • Bevacizumab / administration & dosage
  • Bevacizumab / adverse effects
  • Dihydropyridines
  • Female
  • Follow-Up Studies
  • Humans
  • Intravitreal Injections / adverse effects
  • Male
  • Middle Aged
  • Ranibizumab / administration & dosage
  • Receptors, Vascular Endothelial Growth Factor / administration & dosage
  • Recombinant Fusion Proteins / administration & dosage
  • Recombinant Fusion Proteins / adverse effects
  • Retinal Diseases / drug therapy*
  • Retrospective Studies
  • Stroke / chemically induced
  • Stroke / classification*
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors

Substances

  • Angiogenesis Inhibitors
  • Aptamers, Nucleotide
  • Dihydropyridines
  • Recombinant Fusion Proteins
  • Vascular Endothelial Growth Factor A
  • AE0047
  • aflibercept
  • pegaptanib
  • Bevacizumab
  • Receptors, Vascular Endothelial Growth Factor
  • Ranibizumab