Ocular complications after anti-vascular endothelial growth factor therapy in Medicare patients with age-related macular degeneration

Am J Ophthalmol. 2011 Aug;152(2):266-72. doi: 10.1016/j.ajo.2011.01.053. Epub 2011 Jun 12.


Purpose: To determine longitudinal rates of ocular complications after anti-vascular endothelial growth factor (VEGF) treatment for neovascular age-related macular degeneration (AMD) in a nationally representative longitudinal sample.

Design: Retrospective, longitudinal case-control study.

Methods: Using the Medicare 5% claims database, diagnoses of neovascular AMD and anti-VEGF injections of ranibizumab, bevacizumab, or pegaptanib were identified from International Classification of Diseases and Current Procedural Terminology procedure codes. Six thousand one hundred fifty-four individuals undergoing anti-VEGF treatment for neovascular AMD (total of 40 903 injections) were compared with 6154 matched controls with neovascular AMD who did not undergo anti-VEGF treatment. Propensity score matching was used to match individuals receiving anti-VEGF injections with controls. Rates of postinjection adverse outcomes (endophthalmitis, rhegmatogenous retinal detachment, retinal tear, uveitis, and vitreous hemorrhage) were analyzed by cumulative incidence and Cox proportional hazards model to control for demographic factors and ocular comorbidities.

Results: At the 2-year follow-up, the rates of endophthalmitis per injection (0.09%; P<.01), uveitis (0.11%; P<.01), and vitreous hemorrhage per injection (0.23%; P < .01) were significantly higher in the anti-VEGF treatment group. With Cox proportional hazards modeling, the anti-VEGF treatment group had a 102% higher risk of severe ocular complications overall and a 4% increased risk per injection, both of which were statistically significant (P<.01).

Conclusions: Rates of endophthalmitis, uveitis, and vitreous hemorrhage were higher in the group treated with anti-VEGF injection than in the control group, although these nevertheless were rare in both groups. The overall risk of severe ocular complications was significantly higher in the anti-VEGF treatment group.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged, 80 and over
  • Angiogenesis Inhibitors / therapeutic use*
  • Antibodies, Monoclonal / adverse effects
  • Antibodies, Monoclonal, Humanized
  • Aptamers, Nucleotide / adverse effects
  • Bevacizumab
  • Case-Control Studies
  • Endophthalmitis / diagnosis
  • Endophthalmitis / epidemiology
  • Endophthalmitis / etiology
  • Eye Diseases / diagnosis
  • Eye Diseases / epidemiology
  • Eye Diseases / etiology*
  • Female
  • Follow-Up Studies
  • Health Services Research
  • Humans
  • Incidence
  • Intravitreal Injections / adverse effects*
  • Macular Degeneration / drug therapy*
  • Male
  • Medicare Part B / statistics & numerical data*
  • Proportional Hazards Models
  • Ranibizumab
  • Retinal Detachment / diagnosis
  • Retinal Detachment / epidemiology
  • Retinal Detachment / etiology
  • Retinal Perforations / diagnosis
  • Retinal Perforations / epidemiology
  • Retinal Perforations / etiology
  • Retrospective Studies
  • United States
  • Uveitis / chemically induced
  • Uveitis / diagnosis
  • Uveitis / epidemiology
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors*
  • Vitreous Hemorrhage / diagnosis
  • Vitreous Hemorrhage / epidemiology
  • Vitreous Hemorrhage / etiology


  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Aptamers, Nucleotide
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • pegaptanib
  • Bevacizumab
  • Ranibizumab