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. 2023 Nov 22:17:3613-3627.
doi: 10.2147/OPTH.S441500. eCollection 2023.

Effect of Repeated Intravitreal Injections in Glaucoma Spectrum Diseases

Rodrigo Vilares-Morgado  1   2 , Vera Correia  3 , Ana Margarida Ferreira  1 , Flávio Alves  1 , António Benevides Melo  1   3 , Sérgio Estrela-Silva  1   3 , Joana Araújo  1   3 , João Tavares-Ferreira  1   3 , Marta Silva  1 , Amândio Rocha-Sousa  1   2 , Angela Carneiro  1   2 , João Barbosa-Breda  1   2   4
Affiliations

Effect of Repeated Intravitreal Injections in Glaucoma Spectrum Diseases

Rodrigo Vilares-Morgado et al. Clin Ophthalmol. .

Abstract

Purpose: To evaluate whether repeated intravitreal injections (IVI) with an anti-vascular endothelial growth factor (anti-VEGF) agent are associated with glaucomatous progression in eyes with glaucoma spectrum diseases (GSD).

Methods: Single-center, retrospective, longitudinal study of patients with bilateral and similar GSD who: (1) received ≥8 IVI in only one eye during the study period; (2) had ≥2 retinal nerve fiber layer thickness (RNFL) measurements obtained by spectral-domain optical coherence tomography (SD-OCT) at least 12 months apart. The primary outcome was the absolute RNFL thickness change, comparing injected and fellow uninjected eyes. Linear mixed effects models were constructed, including a multivariable model.

Results: Sixty-eight eyes from 34 patients were included, 34 injected and 34 fellow uninjected eyes. Average baseline age was 67.68±21.77 years with a follow-up of 3.66±1.89 years and 25.12±14.49 IVI. RNFL thickness decreased significantly from 80.92±15.78 to 77.20±17.35 μm (p<0.001; -1.18±1.93 μm/year) in injected eyes and from 79.95±17.91 to 76.61±17.97 μm (p<0.001; -1.07±0.98 μm/year) in uninjected eyes. In a multivariable linear mixed model of injected eyes, only higher baseline RNFL thickness (p < 0.001) significantly predicted higher absolute RNFL thickness loss. Neither absolute RNFL thickness variation (p=0.716) nor RNFL rate (p=0.779) was significantly different between paired injected and uninjected eyes. Absolute IOP variation was not significantly different between groups (16.62±4.77 to 15.09±4.34 mmHg in injected eyes and 17.68±5.01 to 14.50±3.39 mmHg in fellow uninjected eyes; p=0.248). The proportion of eyes receiving glaucoma medical treatment increased significantly in both groups (55.9% to 76.5% in injected eyes; p=0.039; 58.8% to 76.5% in uninjected eyes; p = 0.031). The number of glaucoma medications also increased significantly in both groups (1.03±1.11 to 1.59±1.18 glaucoma medications in injected eyes; p=0.003; 1.09±1.11 to 1.56±1.19 glaucoma medications in uninjected eyes; p=0.003).

Conclusion: Repeated IVI do not seem to accelerate glaucomatous progression. Future studies with a longer follow-up are needed.

Keywords: glaucoma; intravitreal injections; optical coherence tomography; progression; retinal nerve fiber layer thickness.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of study population selection.
Figure 2
Figure 2
Baseline and final RNFL thickness registered throughout follow-up in all study eyes.
See this image and copyright information in PMC

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