Intravitreal vascular endothelial growth factor (VEGF) inhibitor injection in patient during pregnancy

Kianersi, Farzan; Ghanbari, Heshmatollah; Beni, Zahra Naderi; Beni, Afsaneh Naderi

doi:10.1080/21556660.2020.1847926

Cited by 8 publications

(7 citation statements)

References 9 publications

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“…Others have reported uneventful pregnancies with no developmental defects after IVT anti-VEGF administration in pregnancy, though long-term follow-up data is currently not available [ 4 , 9 ]. Administration of IVT anti-VEGF during the embryogenic phase in an otherwise undiagnosed pregnancy has also shown variable results [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Choroidal Neovascularization in Pregnancy: A Case Report

Monis¹,

Ali²,

Bhutto³

et al. 2023

Cureus

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Choroidal neovascularization (CNV) is the abnormal growth of vessels from the choroidal vasculature to the neurosensory retina through the Bruch's membrane and is usually associated with "wet" age-related macular degeneration (AMD). Other causes include myopia, traumatic rupture of the choroid, multifocal choroiditis, and histoplasmosis. CNV is a major cause of visual loss and treatment is aimed at halting progression and stabilizing vision. Intravitreal anti-vascular endothelial growth factor (IVT anti-VEGF) injection is the treatment of choice for CNV regardless of etiology. However, its use in pregnancy is debatable, due to its mechanism of action and lack of evidence of safety in pregnancy.Herein, we report a 27-year-old pregnant female, who complained of blurred and decreased vision in her left eye for two weeks. On examination, her unaided vision was 6/6 in her right eye and 6/18 partial in her left eye with no further improvement. Based on history, examination, and investigations she was diagnosed as a case of idiopathic CNV in pregnancy, being only the sixth reported case worldwide. Citing the risk of possible fetal adverse effects, the patient did not consent to the treatment despite extensive counseling. She was advised to follow up regularly and to receive IVT anti-VEGF injections immediately after delivery.A literature review was therefore undertaken to broaden our understanding of the treatment protocols and outcomes of using IVT anti-VEGF in pregnancy. This helped us to develop an understanding of the possible relative safety of such a treatment when individually tailored with a multi-disciplinary approach.

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Section: Discussionmentioning

confidence: 99%

Idiopathic Choroidal Neovascularization in Pregnancy: A Case Report

Monis¹,

Ali²,

Bhutto³

et al. 2023

Cureus

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“…In line with this, results from the rat diabetic models showed that, the VEGF expression levels in the serum and retina tissues were increased in comparison with normal rats. VEGF and angiogenesis are closely related, and angiogenesis has been proven to be an important feature for the progression of PDR ( 43 ). Therefore, VEGF was a focus of the present investigation.…”

Section: Discussionmentioning

confidence: 99%

Regulatory role of miRNA‑23a in diabetic retinopathy

2021

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The present study aimed to investigate the expression of microRNA (miRNA)-23a in blood and tear samples from diabetic retinopathy (DR) patients. Blood and tear samples were obtained from 33 patients with proliferative DR. Additionally, a rat model of DR was established. Reverse transcription-quantitative PCR was used to determine vascular endothelial growth factor (VEGF) mRNA and miRNA-23a expression levels, while ELISA and western blot analysis were performed to determine protein expression levels. Bioinformatics analysis and dual luciferase reporter assay were used to predict and validate the interaction between miRNA-23a and VEGF and cell proliferative ability was assessed with the MTT assay. In comparison to control patients VEGF mRNA and protein expression levels were significantly elevated in the blood and tear samples from patients with DR, while the expression level of miRNA-23a was significantly reduced. In blood and retinal tissues from a rat model of DR, the mRNA and protein expression levels of VEGF were significantly increased, while the miRNA-23a expression level was significantly decreased relative to controls. Dual luciferase reporter assay showed that miRNA-23a bound to the 3'-untranslated region (UTR) of VEGF. Moreover, over-expression of miRNA-23a significantly reduced the expression level of VEGF and the proliferative activity of human retinal microvascular endothelial cells. The elevated VEGF expression in the blood and tears of patients with DR may be related to the reduced miRNA-23a expression. miRNA-23a may regulate microvascular growth at the retina via VEGF and contribute to DR progression.

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“…However, intravitreal anti-VEGF injections given as early as 5 wk postconception were associated with miscarriage within a week[ 73 ]. A total of 8 papers comprising 16 pregnancies in 15 women using intravitreal bevacizumab have been published since 2009[ 74 - 83 ]. The injection was given between a few days before or after the LMP and during the third trimester.…”

Section: Preparing For Dr Progression In Pregnant Diabeticsmentioning

confidence: 99%

“…The injection was given between a few days before or after the LMP and during the third trimester. There were 5 cases of abortion[ 76 , 79 , 82 , 83 ] and one case of pre-eclampsia[ 80 ] after the use of intravitreal bevacizumab. Petrou et al [ 76 ] described 2 women who received intravitreal bevacizumab at approximately 4 and 3 wk of gestation, respectively, followed by spontaneous miscarriage 7 and 10 d, respectively, after administration of the drug[ 76 ].…”

Section: Preparing For Dr Progression In Pregnant Diabeticsmentioning

confidence: 99%

“…Gómez Ledesma et al [ 79 ] also reported a 41-year-old woman who received intravitreal bevacizumab a few days before or after the LMP and suffered a miscarriage approximately 7 wk after the injection[ 79 ]. Kianersi et al [ 82 , 83 ] reported pregnancy loss within 18 to 24 h in two patients who received intravitreal bevacizumab injection while they were between 10 and 12 wk pregnant[ 82 , 83 ]. Intravitreal bevacizumab given preconception and continued after 29 wk of gestation was associated with preeclampsia requiring urgent caesarean section[ 80 ].…”

Section: Preparing For Dr Progression In Pregnant Diabeticsmentioning

confidence: 99%

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Review of the management of sight-threatening diabetic retinopathy during pregnancy

Choo¹,

Din²,

Azmi³

et al. 2021

WJD

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Diabetes mellitus (DM) is a noncommunicable disease reaching epidemic proportions around the world. It affects younger individuals, including women of childbearing age. Diabetes can cause diabetic retinopathy (DR), which is potentially sight threatening when severe nonproliferative DR (NPDR), proliferative DR (PDR), or sight-threatening diabetic macular oedema (STDME) develops. Pregnancy is an independent risk factor for the progression of DR. Baseline DR at the onset of pregnancy is an important indicator of progression, with up to 10% of women with baseline NPDR progressing to PDR. Progression to sight-threatening DR (STDR) during pregnancy causes distress to the patient and often necessitates ocular treatment, which may have a systemic effect. Management includes prepregnancy counselling and, when possible, conventional treatment prior to pregnancy. During pregnancy, closer follow-up is required for those with a long duration of DM, poor baseline control of blood sugar and blood pressure, and worse DR, as these are risk factors for progression to STDR. Conventional treatment with anti-vascular endothelial growth factor agents for STDME can potentially lead to foetal loss. Treatment with laser photocoagulation may be preferred, and surgery under general anaesthesia should be avoided. This review provides a management plan for STDR from the perspective of practising ophthalmologists. A review of strategies for maintaining the eyesight of diabetic women with STDR with emphasis on prepregnancy counselling and planning, monitoring and safe treatment during pregnancy, and management of complications is presented.

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Intravitreal vascular endothelial growth factor (VEGF) inhibitor injection in patient during pregnancy

Cited by 8 publications

References 9 publications

Idiopathic Choroidal Neovascularization in Pregnancy: A Case Report

Idiopathic Choroidal Neovascularization in Pregnancy: A Case Report

Regulatory role of miRNA‑23a in diabetic retinopathy

Review of the management of sight-threatening diabetic retinopathy during pregnancy

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