Myocardial Infarction, Stroke, and Death after Intravitreal Injection of Anti-VEGF in a Nationwide Study

Area of Science:

• Ophthalmology
• Cardiovascular Medicine
• Public Health

Background:

• Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are common treatments for retinal diseases.
• Concerns exist regarding potential systemic risks, such as myocardial infarction, stroke, and death, following these injections.

Purpose of the Study:

• To evaluate the national-scale risk of myocardial infarction, stroke, and death after intravitreal anti-VEGF injections.
• To compare these risks with those in patients undergoing cataract surgery.

Main Methods:

• A controlled cohort study was conducted in France from 2010 to 2016.
• 334,663 patients receiving anti-VEGF IVT were compared with 981,172 matched controls undergoing cataract surgery.
• Outcomes included myocardial infarction, stroke, or death within 28 days.

Main Results:

• The incidence of myocardial infarction, stroke, or death was low (0.2%) at 28 days in both the anti-VEGF IVT and control groups.
• Multivariable analysis revealed no increased risk of these events in the IVT group (adjusted RR 0.96; 95% CI 0.88-1.05).
• No additional risk was observed in patients with diabetes or prior cardiovascular events, and results were consistent across ranibizumab and aflibercept treatments.

Conclusions:

• The overall risk of major adverse cardiovascular events is low after a single intravitreal anti-VEGF injection.
• There was no significant difference in risk between ranibizumab and aflibercept treatments.
• These findings support the safety profile of anti-VEGF IVT in a large patient population.