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Systemic safety of intravitreal anti-vascular endothelial growth factor agents in age-related macular degeneration

Dedania, Vaidehi S.; Bakri, Sophie J.

Current Opinion in Ophthalmology: May 2016 - Volume 27 - Issue 3 - p 224–243
doi: 10.1097/ICU.0000000000000257
RETINAL, VITREOUS AND MACULAR DISORDERS: Edited by Brandon G. Busbee and John W. Kitchens

Purpose of review The purpose of review is to summarize the literature addressing nonocular adverse events in patients with neovascular age-related macular degeneration treated with intravitreal vascular endothelial growth factor (VEGF) inhibitors and to present possible mechanisms of effect.

Recent findings The incidence of overall nonocular serious adverse events varied from 0 to 39.3% and nonocular adverse events ranged from 0 to 86.9%. Few studies have reported a significant association between use of intravitreal anti-VEGF agents and overall incidence of adverse events, stroke, myocardial infarction, nonocular hemorrhage and death, with overall greater concern in patients treated with bevacizumab. Additionally, history of stroke or other arterial thromboembolic event may be a risk factor for future stroke in patients treated with intravitreal anti-VEGF agents. Theories explaining the mechanisms of increased risk of nonocular adverse events secondary to anti-VEGF agent use surround the necessity of VEGF for the normal functioning of the endothelium and the damage incurred with use of anti-VEGF agents.

Summary Current data are insufficient to definitively conclude that intravitreal anti-VEGF agents are safe, although there is a trend toward an overall favorable systemic safety profile. Caution should be exerted in patients with a history of cardiovascular disease, as these patients may be at greater risk for nonocular serious adverse events.

aDepartment of Ophthalmology and Visual Sciences, University of Michigan, Kellogg Eye Center, Ann Arbor, Michigan

bDepartment of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA

Correspondence to Sophie J. Bakri, MD, Department of Ophthalmology, Mayo Clinic, 200 First Street NW, Rochester, MN 55905, USA. Tel: +1 507 284 3614; fax: +1 507 284 4612; e-mail:

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