• Comprehensive Ophthalmology, Retina/Vitreous

    This retrospective study explored the safety of intravitreal anti-VEGF therapy in patients with diabetic macular edema (DME).

    Study design

    The authors examined records from 23,348 patients with DME, including 13,365 treated with macular laser, 9,219 with intravitreal anti-VEGF and 764 with intravitreal corticosteroid.

    Outcomes

    Anti-VEGF therapy was not associated with increased risk of cerebrovascular disease, major bleeding or heart attack when compared with laser, but there was an increased risk of all-cause hospitalization (HR 1.17; P=0.01). The rate of systemic adverse events were similar between anti-VEGF and corticosteroid therapy.

    Limitations

    This was a retrospective study that has some inherent limitations of a claims database study that rely on chart data recorded in varying practice environments. Patients that received intraocular corticosteroid therapy may have differed from patients receiving anti-VEGF therapy. Specifically, in patients who recently had a stroke or heart attack, the treating clinician may have avoided anti-VEGF therapy. Finally, more than a third of patients in the anti-VEGF group had a switch in therapy during the initial 6 months of treatment; these patients were excluded from some analyses which may have biased the results.

    Clinical significance

    These findings add to the body of evidence suggesting that anti-VEGF therapy does not increase the risk of cardiovascular or cerebrovascular events. The potential increased rate of all-cause hospital admission after initiation of anti-VEGF treatment may merit further investigation, but it is increasingly evident that these medications are well tolerated systemically.

    This study was notable because it looked at a specific disease population, and its findings will be reassuring for patients with DME who may benefit from anti-VEGF treatment.