Transient central retina artery occlusion in patients undergone intravitreal anti-vascular endothelial growth factor injections

Nadyr A. Damasceno, Nicolas A. Yannuzzi, Mauricio Maia, Michel Eid Farah, Harry W. Flynn, Eduardo F. Damasceno

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To evaluate the occurrence of transient central retinal artery occlusion following intravitreal anti-vascular endothelial growth factor injection. Methods: Prospective, observational study of 807 patients (807 eyes) who were given intravitreal injections of ranibizumab or aflibercept to treat any cause of retinal vascular diseases between 1 January 2017 and 30 November 2018 at the Federal Fluminense University Hospital in Niteroi, and a private facility in Rio de Janeiro, Brazil. Patients who did not present transient central retinal artery occlusion were excluded. Results: Among 4069 injections, only 18 patients (0.44%) presented transient central retinal artery occlusion, 14 mild cases (77.7%), and 4 severe cases (22.3%). The clinical factors associated with more severe cases of transient central retinal artery occlusion were the duration of the transient central retinal artery occlusion (p = 0.001), number of prior injections (p = 0.01), and a positive carotid Doppler test (p = 0.01). Twelve cases (66.6%) had positive carotid artery obstruction (atheroma plaque size ≥70%) while 6 cases (33.3%) had negative carotid artery obstruction (atheroma plaque size <70%). The age group >60 years old (p = 0.06), cup/disc ratio >0.6 (p = 0.06), and pseudophakic lens status were also factors with association with transient central retinal artery occlusion, although did not meet criteria for statistical significance. The only patient who experienced a recurrent episode of transient central retinal artery occlusion had diabetic macular edema, positive carotid Doppler test, and cup/optic disc ratio >0.6. Conclusion: Transient central retinal artery occlusion is a rare adverse event that can appear in patients with retinal vascular disease receiving anti-vascular endothelial growth factor therapy. The atheroma plaque size and the number of prior injections can be associated with the severity of the event.

Original languageEnglish (US)
JournalEuropean Journal of Ophthalmology
DOIs
StateAccepted/In press - 2021
Externally publishedYes

Keywords

  • Arterial occlusive disease
  • age-related macular degeneration
  • cystoid macular edema
  • diabetic macular edema
  • venous occlusive disease

ASJC Scopus subject areas

  • Ophthalmology

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