Systemic Outcomes of Intravitreal Injections of Dexamethasone and Anti-Vascular Endothelial Growth Factor

Abstract

Introduction: Intravitreal dexamethasone and anti-vascular endothelial growth factor (anti-VEGF) medications have revolutionized ocular disease management and favorable ocular safety profiles, but few studies have compared their systemic adverse events (SAEs). This study investigated the SAEs of intravitreal dexamethasone and anti-VEGFs by using real-world data.

Methods: This retrospective cohort study sourced medical records from the largest multi-institutional database in Taiwan. Patients who received intravitreal dexamethasone (n = 137) or anti-VEGFs (n = 10,345) between 2014 and 2019 were enrolled. Propensity score matching was performed to achieve homogeneity between the two groups. Subdistribution hazard ratios (SHRs) and 95% confidence intervals (CIs) were calculated using the Fine-Gray model. Systemic as well as ocular clinical events and systemic biomarkers after 1-year follow-up were compared.

Results: Both groups demonstrated comparable risks of major cardiac adverse events (SHR 1.57, 95% CI 0.29-8.55), heart failure (SHR 0.62, 95% CI 0.07-5.33), major bleeding (SHR 0.23, 95% CI 0.03-1.77), all-cause admission (SHR 0.73, 95% CI 0.41-1.30), and all-cause death (SHR 2.11, 95% CI 0.35-12.71). There were no significant differences in longitudinal changes in systolic and diastolic blood pressure, glycated hemoglobin, low-density lipoprotein, estimated glomerular filtration rate, or alanine aminotransferase between the groups. Both groups had a similar incidence of cataract surgery. Although the dexamethasone group exhibited a relatively high prevalence of antiglaucomatous medication use, there was not a significantly higher incidence of glaucoma surgery.

Conclusion: Intravitreal dexamethasone and anti-VEGF medications had comparable systemic safety profiles in our study. Both drugs represent efficacious and safe therapies for ocular diseases.

Keywords: Anti-vascular endothelial growth factor; Dexamethasone; Intravitreal injection; Systemic adverse event; Systemic safety.

Fig. 1

Patient selection flowchart. Anti-VEGF anti-vascular endothelial growth factor agent, IVI intravitreal injection, TA triamcinolone acetonide

Fig. 2

Cumulative event rate of overall complications for patients receiving intravitreal dexamethasone versus intravitreal anti-VEGFs in the propensity-score-matched cohort during 1-year follow-up. Anti-VEGF anti-vascular endothelial growth factor agent, CI confidence interval

Fig. 3

Longitudinal changes in A SBP, B DBP, C HbA1c, D LDL, E eGFR, and F ALT levels in patients who received intravitreal dexamethasone versus those who received intravitreal anti-VEGFs in the propensity-score-matched cohort during 1-year follow-up. ALT alanine aminotransferase, anti-VEGF anti-vascular endothelial growth factor agent, DBP diastolic blood pressure, eGFR estimated glomerular filtration rate, HbA1c glycated hemoglobin, LDL low-density lipoprotein, SBP systolic blood pressure