Ranibizumab and digital ischemia

Abstract

Case report of a patient with age-related macular degeneration whose digital ischemia can most plausibly be attributed to ranibizumab.

Purpose: To report ranibizumab as the probable cause of digital ischemia in a patient treated for age-related macular degeneration.

Methods: Single-patient case report.

Results: An 83-year-old woman with an unremarkable medical history suffered acute ischemia in her left hand with necrosis of the distal phalange of the fifth finger after six intravitreal injections of ranibizumab. Her etiological work-up was negative. Her condition improved after endovascular revascularization and remained good at six months' follow-up after three months of dual antithrombotic therapy (low molecular weight heparin then rivaroxaban, both with aspirin) followed by rivaroxaban alone and four courses of intravenous iloprost.

Conclusion: The increased incidence of peripheral arterial thromboembolic events in patients under ranibizumab treatment is slight but significant, with 0.8-5% of patients affected, most of which suffer strokes. These events seem to occur at a random time after ranibizumab treatment is initiated and no reliable marker has yet been identified. The most probable cause of digital ischemia in our patient was ranibizumab.

Keywords: Anti-VEGF; Digital ischemia; Ischémie digitale; Ranibizumab.