VEGF is reduced in breast milk after intravitreal injection of bevacizumab

Purpose To measure the level of VEGF protein in serum and breast milk after intravitreal injection of bevacizumab and ranibizumab. Methods Serum and breast milk samples before and after repeated intravitreal injections of bevacizumab and ranibizumab were collected from a 35-year old female who was treated for CNV secondary to a chorioretinal scar and who was nursing her 4-month old son. Samples were analysed for the level of VEGF protein via ELISA. Results VEGF protein in the serum was reduced significantly to non-detectable levels after intravitreal injection of bevacizumab and started to recover only after 6 weeks. After intravitreal injection of ranibizumab, however, only a temporary dip 3 days after injection could be detected. VEGF in breast milk was reduced by approximately one third directly after injection of bevacizumab. After injection of ranibizumab, the level of VEGF protein remained unaltered. Conclusion Use of intravitreal VEGF inhibitors should be avoided during pregnancy or while nursing a baby. However, if necessary, ranibizumab seems to have a lower effect on VEGF in the serum or breast milk an should therefore be used.