@article {687, title = {Intravitreal Anti-VEGF Injections in Pregnancy: Case Series and Review of Literature.}, journal = {J Ocul Pharmacol Ther}, volume = {31}, year = {2015}, month = {2015 Dec}, pages = {605-10}, abstract = {

The use of intravitreal antivascular endothelial growth factor (anti-VEGF) injection is gaining wide acceptance as an off-label therapy for diseases that may affect pregnant women. However, these drugs may cause systemic side effects in the mother and fetal harm. This could lead specialists to not administer the drug or women to abort the fetus or to refuse treatment during pregnancy. We report the course of pregnancy in 3 women treated with intravitreal bevacizumab and provide a review of the literature on the use of intravitreal anti-VEGF in pregnancy. Our patients did not have any drug-related adverse event and delivered healthy full-term infants, although one of the women had risk factors for miscarriage. Infants reached all developmental milestones appropriately during infancy. A literature search on the use of intravitreal anti-VEGF injection in pregnancy was undertaken. Data for this review were identified by searches of PubMed and references from relevant articles using the search terms "pegaptanib," "bevacizumab," "ranibizumab," "aflibercept," "anti-VEGF," "intravitreal injection," "pregnant," "pregnancy," "abortion," "miscarriage," "preeclampsia," "embryo-fetal toxicity," "fetal malformations," "teratogenesis," "adverse events," and "maternofetal complications" in multiple combinations. We believe that intravitreal anti-VEGF can be given during pregnancy only when potential benefit to the woman justifies the potential risks to the fetus. When making a decision about whether to give drugs during pregnancy, it is important to consider the timing of exposure and its relationship to windows of developmental sensitivity. We believe that this review will be useful to specialists to inform and possibly treat their pregnant patients.

}, keywords = {Adult, Angiogenesis Inhibitors, Bevacizumab, Female, Humans, Infant, Newborn, Intravitreal Injections, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Risk Factors, Vascular Endothelial Growth Factor A}, issn = {1557-7732}, doi = {10.1089/jop.2015.0056}, author = {Polizzi, Silvio and Mahajan, Vinit B} } @article {745, title = {Aflibercept therapy for exudative age-related macular degeneration resistant to bevacizumab and ranibizumab.}, journal = {Am J Ophthalmol}, volume = {156}, year = {2013}, month = {2013 Jul}, pages = {15-22.e1}, abstract = {

PURPOSE: To evaluate the outcome of intravitreal injection of aflibercept in cases with exudative age-related macular degeneration, (AMD) resistant to injections of bevacizumab or ranibizumab.

DESIGN: Retrospective observational case series.

METHODS: A retrospective chart review at a single institution was conducted to identify patients with exudative AMD and choroidal neovascularization (CNV) in 1 or both eyes resistant to treatment with ranibizumab or bevacizumab who were switched to treatment with at least 3~monthly injections of aflibercept. In total, 36 eyes from 31 patients were included. The demographic data, visual acuities, central macular thickness on optical coherence tomography (OCT), complications, and number of injections were reviewed.

RESULTS: The mean patient age was 79 years (range 60-88). There were 13 male and 18 female patients. The number of prior injections with either bevacizumab or ranibizumab ranged from 6-74. After 3~monthly injections of aflibercept, there was a reduction of either subretinal or intraretinal fluid in 18 of 36 (50.0\%) of the treated eyes; the amount of fluid remained stable in 15 eyes (41.7\%) and worsened in 3 eyes (8.3\%). A significant average decrease was observed for the central macular thickness after 3 injections of 65~μm (P~= 2.9~{\texttimes} 10(-6)), with no significant change in visual acuity.

CONCLUSIONS: Aflibercept therapy appears to be beneficial in a subset of patients with neovascular age-related macular degeneration who exhibit recurrent or resistant intraretinal or subretinal fluid following multiple injections with either bevacizumab or ranibizumab.

}, keywords = {Aged, Aged, 80 and over, Angiogenesis Inhibitors, Antibodies, Monoclonal, Humanized, Bevacizumab, Drug Resistance, Drug Substitution, Exudates and Transudates, Female, Humans, Intravitreal Injections, Male, Middle Aged, Postoperative Complications, Ranibizumab, Receptors, Vascular Endothelial Growth Factor, Recombinant Fusion Proteins, Retina, Retreatment, Retrospective Studies, Subretinal Fluid, Tomography, Optical Coherence, Treatment Outcome, Vascular Endothelial Growth Factor A, Visual Acuity, Wet Macular Degeneration}, issn = {1879-1891}, doi = {10.1016/j.ajo.2013.02.017}, author = {Bakall, Benjamin and Folk, James C and Boldt, H Culver and Sohn, Elliott H and Stone, Edwin M and Russell, Stephen R and Mahajan, Vinit B} } @article {765, title = {Intravitreal bevacizumab for peripapillary choroidal neovascular membranes.}, journal = {Arch Ophthalmol}, volume = {130}, year = {2012}, month = {2012 Aug}, pages = {1073-5}, keywords = {Adult, Aged, Aged, 80 and over, Angiogenesis Inhibitors, Antibodies, Monoclonal, Humanized, Bevacizumab, Choroidal Neovascularization, Female, Fluorescein Angiography, Humans, Intravitreal Injections, Macular Degeneration, Male, Middle Aged, Retreatment, Subretinal Fluid, Tomography, Optical Coherence, Treatment Outcome, Vascular Endothelial Growth Factor A, Visual Acuity}, issn = {1538-3601}, doi = {10.1001/archophthalmol.2012.465}, author = {Davis, Andrew S and Folk, James C and Russell, Stephen R and Sohn, Elliott H and Sohn, Elliot H and Boldt, H Culver and Stone, Edwin M and Mahajan, Vinit B} } @article {783, title = {Uveitis following intravitreal bevacizumab: a non-infectious cluster.}, journal = {Ophthalmic Surg Lasers Imaging}, volume = {42}, year = {2011}, month = {2011 Jul-Aug}, pages = {292-6}, abstract = {

BACKGROUND AND OBJECTIVE: In this retrospective case series, the authors report seven cases of bevacizumab-related uveitis that occurred within a 4-month period.

PATIENTS AND METHODS: Seven eyes of six patients developed non-infectious uveitis following bevacizumab intravitreal injections in a cohort of 978 consecutive bevacizumab injections.

RESULTS: The mean age of patients was 74.6 years (range: 26 to 92). All patients developed symptom onset within 1 day of injection. Shared signs and symptoms included corneal edema, anterior chamber and vitreous cell, conjunctival injection, ocular pain, and lack of hypopyon. In all patients, visual acuity returned to within one line of baseline acuity. All seven eyes had been previously injected with bevacizumab, with a mean number of antecedent injections of 6.1 (range: 3 to 12).

CONCLUSION: A cluster of sterile bevacizumab-related uveitic reactions was described in this case series. Acute onset of symptoms, absence of hypopyon, a predominant anterior segment reaction, and prompt improvement on topical steroid therapy are useful clinical features distinguishing this uveitic syndrome from infectious endophthalmitis.

}, keywords = {Adult, Aged, Aged, 80 and over, Angiogenesis Inhibitors, Antibodies, Monoclonal, Antibodies, Monoclonal, Humanized, Bevacizumab, Humans, Immunosuppressive Agents, Intravitreal Injections, Middle Aged, Retrospective Studies, Uveitis, Anterior, Vascular Endothelial Growth Factor A, Visual Acuity}, issn = {1938-2375}, doi = {10.3928/15428877-20110603-04}, author = {Kay, Christine N and Tarantola, Ryan M and Gehrs, Karen M and Folk, James C and Mahajan, Vinit B and Boldt, H Culver and Syed, Nasreen A and Russell, Stephen R} } @article {161, title = {Intravitreal bevacizumab during pregnancy.}, journal = {Retina (Philadelphia, Pa.)}, volume = {30}, year = {2010}, month = {2010 Oct}, pages = {1405-11}, abstract = {

To report the clinical course of four women treated with intravitreal bevacizumab during pregnancy.

}, keywords = {Adult, Angiogenesis Inhibitors, Antibodies, Monoclonal, Choroidal Neovascularization, Eye Infections, Fungal, Female, Follow-Up Studies, Gestational Age, Histoplasmosis, Humans, Intravitreal Injections, Off-Label Use, Pregnancy, Pregnancy Complications, Sarcoidosis, Tomography, Optical Coherence, Uveitis, Vascular Endothelial Growth Factor A, Visual Acuity}, author = {Tarantola, Ryan M and Folk, James C and Boldt, H Culver and Mahajan, Vinit B} }