ABSTRACT NUMBER: ESOC2026A69 STROKE PATTERNS ON BRAIN IMAGING IN PATIENTS TREATED WITH INTRAVITREAL, ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR (ANTI-VEGF): A SINGLE CENTRE, RETROSPECTIVE REVIEW

Published Date: 06th May 2026

Publication Authors: Jennings. R, Elnagi. F

Background and aims
The effect Intravitreal injection of anti-VEGF agents has on stroke risk is unclear. The aim was to identify themes on neuroimaging regarding the aetiology and distribution of stroke in patients who had been exposed to intravitreal anti-VEGF. If a predominant stroke type became apparent, we would consider how risk factors can be managed in the ophthalmology outpatient setting.

Methods
Records of patients admitted with stroke between 01/01/2024 to 31/03/2025 were analysed for comorbid proliferative diabetic retinopathy (PDR) or exudative age-related macular degeneration (exudative ARMD). These patients were then checked for exposure to intravitreal anti-VEGF. If exposure was found, the patient’s neuroimaging was reviewed to determine the stroke type.

Results
18 patients had been exposed to intravitreal anti-VEGF: 10 for exudative ARMD and 8 for PDR. Ischaemic, non-cortical stroke and small vessel disease related stroke were the most common type, occurring in 12/18 patients (67%), with a predominance amongst patients with ARMD. There were 4 cortical strokes, 1 intracerebral haemorrhage and 1 carotid artery disease related stroke. 78% had MRI available for analysis. Duration of intravitreal anti-VEGF therapy didn't impact stroke type. MRI imaging from 2 patients can be seen in figures 1 and 2

Conclusions
Small vessel disease related stroke predominated. Diabetes, hypertension, hyperlipidaemia, smoking and obesity are well documented, modifiable risk factors for this type of stroke. Collaboration between ophthalmologists and physicians to optimise risk factors prior to initiating intravitreal anti-VEGF is vital. Work is ongoing to develop a panel of tests ophthalmologists can order to aid with risk factor identification.

Jennings, R.; Elnagi, F. (2026). ABSTRACT NUMBER: ESOC2026A69 STROKE PATTERNS ON BRAIN IMAGING IN PATIENTS TREATED WITH INTRAVITREAL, ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR (ANTI-VEGF): A SINGLE CENTRE, RETROSPECTIVE REVIEW. European Stroke Journal. 11(Supp. 1), pp.i655-i656. [Online]. Available at: https://doi.org/10.1093/esj/aakag023.1170 [Accessed 19 August 2026].