Unraveling the effects of serial intravitreal Aflibercept injections on the ocular surface of patients with glaucoma and retinal comorbidity

Abstract

To evaluate ocular surface and eyelid modifications occurring in glaucomatous patients diagnosed with glaucoma therapy-related ocular surface disease (GT-OSD) and retinal comorbidities who previously underwent serial Intravitreal injections (IVIs) of aflibercept. Thirty-two eyes of 32 patients with a diagnosis of GT-OSD and concomitant retinal diseases were enrolled in a two-center retrospective observational study. The main outcome measures were: Noninvasive tear film break-up time (NIBUT), Tear meniscus height (TMH), Bulbar redness score (BRS), fluorescein Tear film Break Up Time (TBUT), Corneal Fluorescence Staining (CFS), Schirmer test I (ST), and inferior eyelid Meibomian Glands (MGs) dropout. Differences between treated and fellow eye (TE, FE), were considered. The median number of IVIs (aflibercept) in TE was 4 (interquartile range (IQR) 3-6.50). Mean BRS was significantly lower (p = 0.011) and median TBUT higher (p = 0.037) in TE compared to FE. Despite CFS and NIBUT did not significantly differ between eyes, their median values showed a marginal tendency for better results in TE compared to FE. Serial IVIs of aflibercept positively affected some features of the GT-OSD, reducing conjunctival hyperemia and improving the tear film stability. These preliminary results could open to new strategies for ocular surface management in glaucoma, whether confirmed in larger prospective studies.

Keywords: Aflibercept; Anti-VEGF; Glaucoma; Glaucoma therapy-related ocular surface disease; Intravitreal injections; Povidone-iodine; Retinal diseases.

Fig. 1

ImageJ-assisted meibomian gland dropout analysis. Mosaic of four meibographies in which the delimited green regions, manually marked, show the area covered by MGs. The dropout area is calculated as the difference between the unmarked and marked area of the tarsum.

Fig. 2

Differences between treated and fellow eyes regarding bulbar redness score (BRS, left), tear film break-up-time (TBUT, right). Boxes represent the median and interquartile range (IQR), error bars represent the range, and dots denote outliers.

Fig. 3

Slit lamp pictures of the ocular surface in a representative glaucomatous patient with GT-OSD, which show a higher hyperemia in the untreated fellow eye (right eye, A-C) compared to the treated eye (left eye, D-F).