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, Kohei 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 1 2019

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Retinal Artery Occlusion
Thrombocytopenia
Heparin
Vascular Endothelial Growth Factor A
Intravitreal Injections
Injections
Pharmaceutical Preparations
Coagulants
Macular Edema
Optical Coherence Tomography
Therapeutics
Visual Fields
Renal Dialysis
Angiography
Blood Platelets
Arteries
Perfusion
aflibercept

All Science Journal Classification (ASJC) codes

  • Ophthalmology

Cite this

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title = "Branch retinal artery occlusion in the untreated contralateral eye following aflibercept injections during heparin treatment: Possible contribution of a heparin-induced thrombocytopenia-like condition",
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.",
author = "shintaro nakao and Makoto Yoshimitsu and Yoshihiro Kaizu and Iori Wada and Muneo Yamaguchi and Kohei Sonoda",
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T1 - Branch retinal artery occlusion in the untreated contralateral eye following aflibercept injections during heparin treatment

T2 - Possible contribution of a heparin-induced thrombocytopenia-like condition

AU - nakao, shintaro

AU - Yoshimitsu, Makoto

AU - Kaizu, Yoshihiro

AU - Wada, Iori

AU - Yamaguchi, Muneo

AU - Sonoda, Kohei

PY - 2019/12/1

Y1 - 2019/12/1

N2 - 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.

AB - 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.

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