title: Adverse events associated with intraocular injections of bevacizumab in eyes with neovascular glaucoma.
abstract: BACKGROUND
  Bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor (VEGF), has been reported to cause rapid regression of anterior segment neovascularization in eyes with neovascular glaucoma when administered intraocularly. Several studies have reported the safety profile of intravitreal injections of bevacizumab in patients with various retinal pathologies. We investigated the occurrence of adverse events associated with intraocular bevacizumab injections in patients with neovascular glaucoma.
  
  
  METHODS
  We retrospectively reviewed the charts of 84 eyes of 70 patients with neovascular glaucoma that received intraocular bevacizumab injections to treat anterior segment neovascularization for the first time at Kanazawa University Hospital.
  
  
  RESULTS
  The mean age of the patients was 63.5 ± 13.3 years (± standard deviation; range, 31-85 years). The underlying retinal diseases were proliferative diabetic retinopathy in 58 eyes (69%), central retinal vein occlusion in 17 eyes (20%), ocular ischemic syndrome in four eyes (5%), central retinal artery occlusion in three eyes (4%), branch retinal vein occlusion in one eye (1%), and radiation retinopathy in one eye (1%). The total number of intraocular injections of bevacizumab was 116 (1.4 ± 0.8 injections/eye, range, one to five injections/eye). Most were intravitreal injections (1.25 mg/0.05 ml; 115 injections, 99%). No cases had marked inflammation, lens injuries, marked vitreous hemorrhage, retinal detachment, or endophthalmitis. However, two eyes (2%) of two cases (3%) developed central retinal artery occlusion 3 or 4 days after bevacizumab injection. Both were among four eyes (i.e., 50%) with ocular ischemic syndrome. One of them had received an intracameral injection of bevacizumab (0.75 mg/0.03 ml) before the adverse event. No cases experienced systemic side-effects including myocardial infarction and cerebrovascular accidents within 3 months after bevacizumab injection.
  
  
  CONCLUSIONS
  Central retinal artery occlusion may be a relatively common complication following intraocular injection of anti-VEGF agents in patients with neovascular glaucoma, particularly when it was associated with ocular ischemic syndrome. Since visual prognosis of central retinal artery occlusions is usually poor, intraocular injection of anti-VEGF agents should be performed with thoughtful consideration of the risks and benefits of the treatment, and with a strict follow-up examination, especially in high-risk patients.
authors: Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, 920-8641, Japan. eyetomo@kenroku.kanazawa-u.ac.jp
authors: Tomomi
authors: T
authors: Higashide
authors: Eiji
authors: E
authors: Murotani
authors: Yoshiaki
authors: Y
authors: Saito
authors: Shinji
authors: S
authors: Ohkubo
authors: Kazuhisa
authors: K
authors: Sugiyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D000869:Anterior Eye Segment / Q000098:blood supply; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D000068258:Bevacizumab; D002343:Carotid Artery, Internal / Q000187:drug effects; D016893:Carotid Stenosis / Q000209:etiology; D005260:Female; D005451:Fluorescein Angiography; D015355:Glaucoma, Neovascular / Q000188:drug therapy*; D006801:Humans; D056965:Injections, Intraocular; D007429:Intraocular Pressure; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015356:Retinal Artery Occlusion / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab