A 68-year-old man suffered an ischemic stroke 5 weeks ago and now needs treatment for active neovascular AMD. What is the principal systemic concern that governs the choice and timing of intravitreal anti-VEGF therapy in such a patient?
- A Arterial thromboembolic events, since VEGF inhibition may increase this risk ✓
- B Hypertensive crisis from transient systemic vasoconstriction
- C Haemorrhagic transformation due to platelet aggregation induced by anti-VEGF agents
- D Acute kidney injury from systemic VEGF neutralisation
Correct answer: A. Arterial thromboembolic events, since VEGF inhibition may increase this risk
Explanation
Systemic VEGF inhibition has been associated with an increased rate of arterial thromboembolic events, including cerebrovascular accidents, myocardial infarction and vascular death, a risk documented with both intravitreal and systemic anti-VEGF exposure. Therapy is generally deferred until the peri-stroke period has stabilised and cardiovascular risk is reviewed. Anti-VEGF agents do not induce platelet aggregation, and hypertensive crisis or AKI are not recognized consequences of intravitreal dosing.
Reference: Kanski's Clinical Ophthalmology, 10th ed.
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