Vitiligo following intravitreal ranibizumab: An association or an unrelated event?

Age-related macular degeneration (ARMD) is the most common cause for visual impairment in the elderly in western countries. Its incidence in India is expected to increase with the increase in the size of geriatric population. Recently several anti-vascular endothelial growth factor (VEGF) drugs like pegaptanib sodium (Macugen), ranibizumab (Lucentis) and bevacizumab (Avastin) are available for use in the management of wet ARMD. Besides being too expensive, long term results of these drugs are not available as of now. A 65 yrs old patient diagnosed with wet ARMD was given intra-vitreal Ranibizumab. He developed vitiligo involving both hands post injection. To the best of our knowledge this is the first reported case Ranibizumab-induced vitiligo. It not only draws attention to the fact that VEGF receptors have an important role in pathogenesis of vitiligo but also to the commonly ignored area of systemic side-effects of intra-vitreal anti-VEGF therapy.