What is the evidence for systemic effects of intravitreal anti-VEGF agents, and should we be concerned?

11 In BEAT-ROP, there was an imbalance in deaths, with two in the laser arm and five in the bevacizumab arm, and this imbalance was more notable in respiratory deaths (one in the laser arm and four in the bevacizumab arm); however, these differences did not reach statistical significance. 32 An additional reason to reconsider dosing was provided by Lutty et al who used a canine model of ROP that mimics the size of human ROP eyes. 37 He showed that 5 μg of intravitreal VEGF trap inhibits the abnormal retinal neovascularisation without impairing retinal vasculogenesis or revascularisation as did higher doses.

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