Incidence of Blepharoptosis Following Intravitreal Anti-Vascular Endothelial Growth Factor Injections

Abstract

Purpose: To determine the incidence of blepharoptosis after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections and compare the rates of blepharoptosis between patients injected with an eyelid speculum and those injected without a speculum.

Design: Retrospective cohort study.

Methods: International Classification of Diseases, Tenth Revision (ICD-10), codes were used to identify patients with exudative age-related macular degeneration (AMD) and those who developed ptosis after intravitreal injections. Patients with nonexudative AMD who did not receive intravitreal injections served as controls. The outcomes were the incidence of ptosis in the injection group compared to the noninjection group and incidence of ptosis in patients whose injections were performed with an eyelid speculum as compared to those whose injections were performed without a speculum.

Results: We recruited 1100 exudative AMD patients who received at least 1 intravitreal anti-VEGF injection and 2258 nonexudative AMD patients who had not received an injection. In the injection group, 18 of 1100 patients (1.6%) developed ptosis, compared with 52 of 2258 patients (2.3%) in the noninjection group (P = .25). Within the injection group, ptosis was mostly bilateral, diagnosed on average 22.4 months after the initial injection, and after more than a 1-year injection-free period. Eleven of 537 patients (2.0%) injected without a speculum developed ptosis, compared with 8 of 444 patients (1.8%) injected with a speculum (P = .82).

Conclusions: No statistically significant differences in incidence rates of ptosis were observed. In this analysis, neither intravitreal anti-VEGF injections nor speculum use during injections appears to increase the risk of ptosis.

Figure 1.

Comparison of the incidence rate of ptosis between the non-injection and the injection group. 2.3% of patients in the control vs. 1.6% of patients in the treatment group developed ptosis. Two-tailed Fisher’s exact test yielded a statistically non-significant p value of 0.25.

Figure 2.

Comparison of the incidence rate of ptosis between the non-speculum group and the speculum group. 2.0% of the speculum group vs. 1.8% of the non-speculum group developed ptosis. Two-tailed Fisher’s exact test yielded a statistically non-significant p value of 0.82.