Systemic and Ocular Risks Associated With Therapies for Macular Degeneration: Clarification vs Confusion

Understanding the possible safety issues related to anti–vascular endothelial growth factor agents as used in ophthalmology is important, and Curtis et al¹ attempted to clarify these issues. Independent of the risks inherent in intravitreous injections themselves (endophthalmitis, cataract) or concerns about just how a batch of bevacizumab-filled syringes was compounded, systemic safety questions still linger. Apparent higher incidences of cerebrovascular accident and myocardial infarction (MI) were intermittently signaled during the ANCHOR and SAILOR clinical trials of ranibizumab.² Although the overall significance was difficult to interpret, 2 subsequent independent meta-analyses of these and other studies^3- 4 continue to raise questions of the potential stroke risks of intravitreous ranibizumab, particularly in patients who had already had such an event. Even if such risks are small, there is physiological plausibility for having such concerns, especially when using a pan–vascular endothelial growth factor inhibitor (bevacizumab and ranibizumab).^2,5