Table 5.
Cardiovascular effects of repeated intravitreal anti-VEGF therapy
| Author, year | Type of study | Anti-VEGF agent(s) | Results | Inference |
|---|---|---|---|---|
| Kwon et al. 2018 [50] | Retrospective study investigating MI within 2 months of anti-VEGF injections | Bevacizumab | No difference in MI prevalence by retinal disease; MI associated with prior MI/CVA | Caution advised before administering anti-VEGF in patients with MI risk factors |
| Dalvin et al. 2019 [51] | Population-based cohort study of patients with exudative ARMD (2004–2013) | Pegaptanib, bevacizumab, ranibizumab, aflibercept | Anti-VEGF therapy was not associated with increased MI risk versus controls | Cardiac events not attributable to anti-VEGF therapy in exudative ARMD |
| Chen et al. 2021 [52] | Retrospective population-based study comparing IVI versus non-IVI groups in patients with prior MI/stroke | Not specified | IVI group had significantly higher mortality, especially when injections occurred within 1 year of prior MI/stroke | Increased mortality risk associated with anti-VEGF in post-MI/stroke patients |
| Chou et al. 2023 [49] | Nationwide population-based cohort study analyzing ATE risk | Ranibizumab, aflibercept | 38 ATEs in 6 months post-injection; IVR had lower ATE risk than IVA; higher ATE risk in patients with recent MI/IS or CAD | IVR may be safer than IVA in patients with recent cardiovascular events; caution recommended |
| Lai et al.. 2024 [53] | Retrospective study of diabetic patients without prior CVD; compared anti-VEGF versus laser/steroid cohort | Bevacizumab, ranibizumab, aflibercept, faricimab, brolucizumab | No acute MI events at 1 month; similar MI incidence at 6 and 12 months across groups | Anti-VEGF therapy appears safe in diabetic patients without baseline CVD |
| Sui et al. 2024 [54] | Case report of elderly patient with 10 years of anti-VEGF therapy | Ranibizumab, conbercept, aflibercept | Unexpected cardiac dysfunction observed; improvement after discontinuation of anti-VEGF | Suggests importance of cardiac monitoring in elderly and long-term anti-VEGF users |
Abbreviations: MI myocardial infarction, CVA cerebrovascular accident, ARMD age-related macular degeneration, IVI intravitreal injection, ATE arterial thromboembolic events, CAD coronary artery disease, IS ischemic stroke, IVR intravitreal ranibizumab, IVA intravitreal aflibercept, CVD cardiovascular disease, VEGF vascular endothelial growth factor