Título / Title

TRANSITORY CENTRAL RETINAL ARTERY OCCLUSION AFTER INTRAVITREAL ANTI-VEGF INJECTIONS: A CASE SERIES STUDY ANALYZING A RARE ADVERSE EVENT

Introdução / Purpose

To evaluate a rare adverse event (AE) of intravitreal anti-VEGF injection, the transitory central retinal artery occlusion (tCRAO)

Material e Método / Methods

This is a prospective case series study of 4069 anti-VEGF injections (807 patients). Patients who underwent intravitreal injections of Ranibizumab or Aflibercept to treat retinal diseases were included. tCRAO was defined as a sudden optic disc pallor and lack of pulsation of the central retinal artery, associated with unilateral painless loss of vision occurring immediately after the injection, lasting a few minutes. Those cases were divided in mild and severe cases, depending in gravity and response to treatment, statistical tests were made to analyze and compare both groups

Resultados / Results

A total of 18 patients (0.44%) presented tCRAO, being separated in 14 mild cases and 4 severe cases, the mean age was 65.3 ± 8.93 years old, and was more frequent in females (61.1%). Of those patients, 9 had glaucoma, 5 had NAION, 8 had ischemic systemic disease and 8 had carotid artery occlusion. Among the retinal diseases, 5 patients had AMD, 9 had DME, 3 had retinal vein occlusion and 1 had myopic macular degeneration. Regarding the number of injections until the occurrence of the AE, 7 patients received just 1 injection, 6 patients received 2 injections and 3 patients received more than 3 injections. The mean IOP varied from 18.1 ± 2.20 mmHg, before the intravitreal injection, to 20.2 ± 1.75 mmHg just after the AE. When comparing mild and severe cases, the last one presented higher cup/optic disc ratio (p=0.03), positive carotid doppler test (p=0.01) and lower number of prior injections (p=0.01)

Discussão e Conclusões / Conclusion

tCRAO is a rare adverse event with a tendency to occur more often in eyes with diabetic macular edema, after the first or second intravitreal injection of anti-VEGF, predominantly in female and elders over 60 years-old. Positive carotid Doppler test and higher cup/optic disc ratio could predict more severe cases

Palavras Chave

Intravitreal Injections, Anti –VEGF, CRAO, Retinal Procedures Adverse Events, Transitory Side effects