Erectile dysfunction following intravitreal bevacizumab

Abstract

Despite initial concerns regarding systemic complications, the use of intravitreal antivascular endothelial growth factor (anti-VEGF) agents for ocular disease is rapidly expanding worldwide, in terms of both the number of patients injected and its indications. To our knowledge, there are no cases in the literature reporting erectile dysfunction following the use of intravitreal bevacizumab. We postulate an organic mechanism for impaired erectile function due to systemically absorbed intravitreal bevacizumab. We describe a case of erectile dysfunction following intravitreal bevacizumab administration. Color fundus photos, fluorescein angiogram and optical coherence tomography images are presented. A 40-year-old male underwent intravitreal bevacizumab therapy for macular edema secondary to a branch retinal vein occlusion. He subsequently developed transient erectile dysfunction after each of his two bevacizumab injections. His only comorbidity was mild hypertension. Erectile dysfunction may be a side effect of intravitreal bevacizumab. The erectile dysfunction could be organic and/or psychogenic in etiology.

Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature

“…Rare ocular adverse events include anterior ischemic optic neuropathy after bevacizumab injection, 52,53 retinal venous occlusions after bevacizumab injection, 54 retinal artery occlusions, 55 hemorrhagic macular infarction, 56 development or exacerbation of ocular ischemic syndrome, 57 and sixth nerve palsy following bevacizumab injection. 58 Rare systemic events include formed visual hallucinations, 59 erectile dysfunction, 60 and acute decrease in kidney function. 61 The causative role of anti-VEGF agents in these cases remains to be established.…”

Erectile Dysfunction Etiological Factors

“…The mechanism is not well established, but it is postulated that the systemic drug absorption may lead to an interaction with nitric oxide in the corpus cavernosum (Yohendran & Chauhan, 2010). .…”

“…Moreover, injection trauma can be associated with psychological effect, leading to temporary loss of erection. (Yohendran & Chauhan, 2010 …”

Paralytic ileus after bilateral intravitreal injection of bevacizumab

“…There are few reports of systemic adverse events associated with intravitreal injection of bevacizumab (IVB). Rare systemic events include formed visual hallucinations,[ 1 ] erectile dysfunction,[ 2 ] and acute decrease in kidney function. [ 3 ] We recently experienced a case of paralytic ileus after bilateral IVB, thus herein report the case.…”