Nakao Shintaro, Yoshimitsu Makoto, Kaizu Yoshihiro, Wada Iori, Yamaguchi Muneo, Sonoda Koh-Hei
Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan.
Am J Ophthalmol Case Rep. 2019 Aug 28;16:100549. doi: 10.1016/j.ajoc.2019.100549. eCollection 2019 Dec.
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.
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.
Previous and 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.
在本研究中，我们报告了一例在全身应用肝素期间接受阿柏西普治疗后次日，对侧眼发生视网膜分支动脉阻塞（BRAO）的病例。
一名患有糖尿病性黄斑水肿的63岁女性，其左眼反复接受抗VEGF药物（0.5mg雷珠单抗或2mg阿柏西普）玻璃体内注射。在玻璃体内注射阿柏西普后的第二天，她在使用抗凝剂肝素进行血液透析期间，出现了突然的无痛性视力模糊，仅局限于对侧眼（右眼）的下方视野缺损。光学相干断层扫描血管造影（OCTA）显示动脉灌注减少，患者被诊断为对侧BRAO。
既往研究报告抗VEGF药物的Fc部分可与肝素共同激活血小板。因此，在同时进行肝素治疗的情况下，可能需要谨慎选择抗VEGF药物。
