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Systemic adverse events and all-cause mortality following same-session bilateral intravitreal anti-VEGF injections: a systematic review

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Abstract

Purpose

To review the risk of systemic adverse events and all-cause mortality following same-day bilateral anti-VEGF injections.

Methods

Twelve literature databases were searched for studies on same-session bilateral intravitreal anti-VEGF injections. Studies reporting on systemic adverse events and mortality were included. Data extraction was made independently by two authors and discussed afterwards until consensus was reached.

Results

Seven studies were included with a total of 13,406 intravitreal anti-VEGF injections (6703 bilateral injections sessions) given to 689 patients. Across all studies, mean age of patients ranged from 55.7 to 82.5 years, and mean follow-up times ranged from 1.3 to 41 months. Six studies reported on systemic adverse events: Two cases of non-fatal cardiac adverse events were reported after 12,964 injections (6482 bilateral injection sessions) in 626 patients. Four studies reported on death: 12 deaths were recorded after 6233 bilateral injection sessions in a total population of 554 subjects.

Conclusions

We suggest that the risk of non-fatal systemic adverse events and death after same-session bilateral anti-VEGF injection is reasonably low, but larger studies with follow-ups of several years are needed to quantify the exact risk.

Study registration.

Prospectively registered in PROSPERO, registration ID: CRD42023428254, registration date: 20/05/2023.

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Fig. 1

Adapted from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org

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Data availability

Data sharing is available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Ophthalmology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark

    Jakob Bjerager, Javad Hajari, Oliver Niels Klefter, Yousif Subhi & Miklos Schneider

  2. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Oliver Niels Klefter

  3. Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    Yousif Subhi

  4. Department of Ophthalmology, Semmelweis University, Budapest, Hungary

    Miklos Schneider

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  1. Jakob Bjerager
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  2. Javad Hajari
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  4. Yousif Subhi
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  5. Miklos Schneider
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Contributions

Conceptualization: MS, JB, and YS; methodology: YS and JB; literature search: YS; data extraction and analysis: JB, MS, ONK, and YS; data interpretation: JB, JNH, ONK, YS, and MS; writing—original draft preparation: JB; and writing—review and editing: MS, YS, JNH, and ONK. All authors read and approved the final manuscript. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Miklos Schneider.

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Ethical approval

Not applicable. According to Danish law, institutional review board approval is not required for systematic reviews.

Consent to participate

This article does not contain any studies with human participants or animals performed by any of the authors.

Conflict of interest

Author M. S. has received investigator fees from Allergan, Bayer, Novartis, and Roche and has served as an advisory board member for Novartis and Roche and acted as consultant for AbbVie, not related to this work. Author Y. S. declares to have received speaker fees from Bayer and Roche, not related to this work. Other authors declare that no potential conflicts of interests exist in relation to this work.

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Bjerager, J., Hajari, J., Klefter, O.N. et al. Systemic adverse events and all-cause mortality following same-session bilateral intravitreal anti-VEGF injections: a systematic review. Graefes Arch Clin Exp Ophthalmol (2024). https://doi.org/10.1007/s00417-023-06368-8

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  • DOI: https://doi.org/10.1007/s00417-023-06368-8

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