Branch retinal artery occlusion in the untreated contralateral eye following aflibercept injections during heparin treatment: Possible contribution of a heparin-induced thrombocytopenia-like condition

Shintaro Nakao, Makoto Yoshimitsu, Yoshihiro Kaizu, Iori Wada, Muneo Yamaguchi, Koh Hei Sonoda

Research output: Contribution to journalArticle

Abstract

Purpose: In this study, we report a case of branch retinal artery occlusion (BRAO) in the contralateral eye the day after aflibercept treatment during systemic heparin administration. Observations: A 63-year-old woman with diabetic macular edema underwent repeated intravitreal injection of anti-VEGF drugs (0.5mg ranibizumab or 2mg aflibercept) for her left eye. The day after intravitreal injection of aflibercept, she presented with sudden painless blurred vision that was limited to the inferior visual field defect in the contralateral eye (right eye) during hemodialysis with the anti-coagulant heparin. Optical coherence tomography angiography (OCTA) showed decreased artery perfusion and the patient was diagnosed with contralateral BRAO. Conclusions: Previous in vitro and in vivo studies have reported that the Fc portion of anti-VEGF drugs activates platelets with heparin. Therefore, careful anti-VEGF drug selection may be necessary in cases with concomitant heparin treatment.

Original languageEnglish
Article number100549
JournalAmerican Journal of Ophthalmology Case Reports
Volume16
DOIs
Publication statusPublished - Dec 2019

All Science Journal Classification (ASJC) codes

  • Ophthalmology

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