TOPLINE: 

Patients who received eye injections of anti-VEGF agents around the time of a stroke or myocardial infarction did not have an increased risk for mortality or major complications, and outcomes did not vary among commonly used anti-VEGF drugs.

METHODOLOGY:  

• Researchers conducted a retrospective cohort study using data from electronic health records from a large US network (2005-2025) to assess whether anti-VEGF eye injections given around the time of a cardiovascular event affected survival and major complications.
• They identified patients who were previously exposed to anti‑VEGF therapy and experienced stroke or myocardial infarction. Those who received an injection 14 days before to 6 weeks after the cardiovascular event were propensity score-matched to control patients with prior history of anti‑VEGF injections but not within 3 months before or after the event.
• The matched cohorts of patients exposed to anti‑VEGF injections included 1526 who experienced stroke (mean age, 72.1 years; 53.9% women) and 1523 who experienced myocardial infarction (mean age, 71.4 years; 46.9% women), each mirrored by an equal number of control individuals.
• Clinical outcomes were all-cause mortality, neurologic deficits persisting after stroke, and systolic heart failure after myocardial infarction, assessed at 3 months and 1 year.
• Researchers also ran analyses limited to injections administered within 14 days before the cardiovascular event and compared outcomes across different anti-VEGF agents.

TAKEAWAY:

• Compared with control individuals, patients who received anti-VEGF injections around the time of a stroke had a reduced risk for mortality at 3 months and 1 year (relative risks [RRs], 0.39 and 0.52, respectively; P < .001 for both) and a reduced risk for lasting neurologic deficits at 3 months (RR, 0.64; P = .007) but not at 1 year.
• Patients who received anti-VEGF injections around the time of a myocardial infarction had a reduced risk for mortality at 3 months and 1 year (RRs, 0.34 and 0.58, respectively; P < .001 for both) and a reduced risk for heart failure at 3 months (RR, 0.65; P = .02) but not at 1 year.
• The reduced risk for mortality persisted when exposure was limited to injections given within 14 days before the cardiovascular event, but differences in the risk for neurologic deficits and heart failure became nonsignificant.
• Outcomes did not differ by the choice of anti-VEGF agent (aflibercept, bevacizumab, or ranibizumab).

IN PRACTICE:

The findings “suggest that delaying anti-VEGF or modifying agent selection in the peri-CVE [cardiovascular event] period may be unnecessary and that clinical decision-making can safely prioritize continued anti-VEGF therapy without modification during the peri-CVE period while preserving vision and avoiding added systemic risk,” the researchers reported.

“While it is perhaps too soon to speak about a protective effect of intraocular anti-VEGF therapy on occurrence of CVEs, we welcome the results of [this study] which, in more detail, expands on some pilot reports showing that intravitreal anti-VEGF pharmacotherapy is safe in patents with recent CVEs and cerebrovascular events,” Igor Kozak, MD, PhD, wrote in an invited commentary accompanying the journal article.

SOURCE:

The study was led by Darius D. Bordbar, MD, of Harvard Medical School in Boston. It was published online on March 26 in JAMA Ophthalmology.

LIMITATIONS:

The study was observational and thus was susceptible to confounding and errors in coding. Information on the severity of cardiovascular events and injection counts was unavailable. Some drug-specific cohorts were relatively small to support reliable conclusions.

DISCLOSURES:

The study received support in part from the Heed Ophthalmic Foundation Fellowship. Two authors reported receiving consultant fees from multiple pharmaceutical and eyecare companies. One of them also reported receiving research funding, royalties, and grants outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.