Sequential anterior ischemic optic neuropathy and central retinal artery and vein occlusion after ranibizumab for diabetic macular edema

Maurizio Battaglia Parodi, Pierluigi Iacono, Maria Lucia Cascavilla, Ilaria Zucchiatti, Dimitris Stelios Kontadakis, Stefano Vergallo, Francesco Bandello

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

PURPOSE. To describe a rare adverse event characterized by anterior ischemic optic neuropathy (AION) associated with central retinal artery occlusion (CRAO) followed by central retinal vein occlusion (CRVO) secondary to treatment with intravitreal injection of ranibizumab for diabetic macular edema (DME). METHODS. A patient with DME refractory to focal grid laser photocoagulation in the left eye was prospectively followed and treated with intravitreal injection of ranibizumab. Over a 12-month period and after 4 injections, best-corrected visual acuity (BCVA) improved from 20/63 to 20/50 (Snellen equivalent) and central retinal thickness (CRT) reduced from 551 to 279 μm. In July 2009, BCVA dropped to 20/100 with CRT of 421 μm due to the recurrence of DME and a further injection was administered. RESULTS. One month later, the left eye showed a sudden visual acuity loss. Best-corrected visual acuity was 20/400 and the fundus examination revealed a hyperemic and swollen optic disc, with several retinal hemorrhages. Retina at the posterior pole was pale, with attenuation and sheathing of arterial vessels. Fluorescein angiography showed a delayed optic disc and arterial filling with retinal ischemia involving both posterior pole and periphery and confirmed the diagnosis of AION associated with CRAO. One month later, the BCVA decreased to 20/800, and fundus examination evidenced a CRVO with diffuse retinal hemorrhages in the 4 quadrants, congestion, and tortuosity of the retinal veins. CONCLUSIONS. Although severe ocular adverse events are generally rare, patients receiving intraocular anti-vascular endothelial growth factor injection should be monitored carefully for the development of vascular complications.

Original languageEnglish
Pages (from-to)1076-1078
Number of pages3
JournalEuropean Journal of Ophthalmology
Volume20
Issue number6
Publication statusPublished - Nov 2010

Fingerprint

Retinal Artery Occlusion
Ischemic Optic Neuropathy
Retinal Vein
Retinal Vein Occlusion
Macular Edema
Visual Acuity
Retinal Hemorrhage
Intravitreal Injections
Optic Disk
Injections
Fluorescein Angiography
Light Coagulation
Vascular Endothelial Growth Factor A
Blood Vessels
Retina
Lasers
Ischemia
Ranibizumab
Recurrence

Keywords

  • Anti-VEGF
  • Diabetic macular edema
  • Intravitreal injection
  • Ranibizumab

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Sequential anterior ischemic optic neuropathy and central retinal artery and vein occlusion after ranibizumab for diabetic macular edema. / Parodi, Maurizio Battaglia; Iacono, Pierluigi; Cascavilla, Maria Lucia; Zucchiatti, Ilaria; Kontadakis, Dimitris Stelios; Vergallo, Stefano; Bandello, Francesco.

In: European Journal of Ophthalmology, Vol. 20, No. 6, 11.2010, p. 1076-1078.

Research output: Contribution to journalArticle

Parodi, Maurizio Battaglia ; Iacono, Pierluigi ; Cascavilla, Maria Lucia ; Zucchiatti, Ilaria ; Kontadakis, Dimitris Stelios ; Vergallo, Stefano ; Bandello, Francesco. / Sequential anterior ischemic optic neuropathy and central retinal artery and vein occlusion after ranibizumab for diabetic macular edema. In: European Journal of Ophthalmology. 2010 ; Vol. 20, No. 6. pp. 1076-1078.
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AU - Parodi, Maurizio Battaglia

AU - Iacono, Pierluigi

AU - Cascavilla, Maria Lucia

AU - Zucchiatti, Ilaria

AU - Kontadakis, Dimitris Stelios

AU - Vergallo, Stefano

AU - Bandello, Francesco

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N2 - PURPOSE. To describe a rare adverse event characterized by anterior ischemic optic neuropathy (AION) associated with central retinal artery occlusion (CRAO) followed by central retinal vein occlusion (CRVO) secondary to treatment with intravitreal injection of ranibizumab for diabetic macular edema (DME). METHODS. A patient with DME refractory to focal grid laser photocoagulation in the left eye was prospectively followed and treated with intravitreal injection of ranibizumab. Over a 12-month period and after 4 injections, best-corrected visual acuity (BCVA) improved from 20/63 to 20/50 (Snellen equivalent) and central retinal thickness (CRT) reduced from 551 to 279 μm. In July 2009, BCVA dropped to 20/100 with CRT of 421 μm due to the recurrence of DME and a further injection was administered. RESULTS. One month later, the left eye showed a sudden visual acuity loss. Best-corrected visual acuity was 20/400 and the fundus examination revealed a hyperemic and swollen optic disc, with several retinal hemorrhages. Retina at the posterior pole was pale, with attenuation and sheathing of arterial vessels. Fluorescein angiography showed a delayed optic disc and arterial filling with retinal ischemia involving both posterior pole and periphery and confirmed the diagnosis of AION associated with CRAO. One month later, the BCVA decreased to 20/800, and fundus examination evidenced a CRVO with diffuse retinal hemorrhages in the 4 quadrants, congestion, and tortuosity of the retinal veins. CONCLUSIONS. Although severe ocular adverse events are generally rare, patients receiving intraocular anti-vascular endothelial growth factor injection should be monitored carefully for the development of vascular complications.

AB - PURPOSE. To describe a rare adverse event characterized by anterior ischemic optic neuropathy (AION) associated with central retinal artery occlusion (CRAO) followed by central retinal vein occlusion (CRVO) secondary to treatment with intravitreal injection of ranibizumab for diabetic macular edema (DME). METHODS. A patient with DME refractory to focal grid laser photocoagulation in the left eye was prospectively followed and treated with intravitreal injection of ranibizumab. Over a 12-month period and after 4 injections, best-corrected visual acuity (BCVA) improved from 20/63 to 20/50 (Snellen equivalent) and central retinal thickness (CRT) reduced from 551 to 279 μm. In July 2009, BCVA dropped to 20/100 with CRT of 421 μm due to the recurrence of DME and a further injection was administered. RESULTS. One month later, the left eye showed a sudden visual acuity loss. Best-corrected visual acuity was 20/400 and the fundus examination revealed a hyperemic and swollen optic disc, with several retinal hemorrhages. Retina at the posterior pole was pale, with attenuation and sheathing of arterial vessels. Fluorescein angiography showed a delayed optic disc and arterial filling with retinal ischemia involving both posterior pole and periphery and confirmed the diagnosis of AION associated with CRAO. One month later, the BCVA decreased to 20/800, and fundus examination evidenced a CRVO with diffuse retinal hemorrhages in the 4 quadrants, congestion, and tortuosity of the retinal veins. CONCLUSIONS. Although severe ocular adverse events are generally rare, patients receiving intraocular anti-vascular endothelial growth factor injection should be monitored carefully for the development of vascular complications.

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