The Risk of Non-arteritic Ischemic Optic Neuropathy Post-intravitreal Bevacizumab Injection

Objectives: To report the incidence of non-arteritic ischemic optic neuropathy in diabetic patients treated with intravitreal bevacizumab injection. Methods: A prospective comparative analytic study was done in the King Hussein Medical Center during the period between June 2020 and June 2021. Inclusion criteria included diabetic patients who attended a retina clinic. Exclusion criteria included patients with pre-existing ischemic optic neuropathy. Patients were divided into two groups. The first group included diabetic patients who did not require bevacizumab injection and were treated either with follow-up visits or pan-retinal photocoagulation, and the second group included patients who were treated with intravitreal bevacizumab. Patients were followed up for a period of one year. Data collected in two groups included the total number of patients and the number of patients with non-arteritic ischemic optic neuropathy. Results were compared in both groups. A P-value was used to study the statistical significance and was considered to be statistically significant if ≤0.05. Results: The mean age for patients in group 1 was 64.3 years, with a male to female ratio of 1.1 to 1. In group 2, the mean age was 66.2 years, with a male to female ratio of 1.2 to 1. The total number of patients in group 1 was 7375, among whom 68 patients had non-arteritic ischemic optic neuropathy. While in group 2, the total number was 2468 and 49 of them had non-arteritic ischemic optic neuropathy. Most cases of non-arteritic ischemic optic neuropathy were seen in patients who had received three or more injections. Conclusion: Intravitreal bevacizumab in diabetic patients is considered a risk factor for the development of non-arteritic ischemic optic neuropathy, especially in patients receiving more than three injections.