Effect of Repeated Intravitreal Injections in Glaucoma Spectrum Diseases

Autores da FMUP

• Rodrigo Manuel Robalo Curado De Vilares Morgado

  Autor

• Amândio António Rocha Dias De Sousa

  Autor

• João Filipe Barbosa Breda

  Autor

Participantes de fora da FMUP

• Correia, V
• Ferreira, AM
• Alves, F
• Melo, AB
• Estrela-Silva, S
• Araújo, J
• Tavares-Ferreira, J
• Silva, M
• Carneiro, A

Unidades de investigação

• Cirurgia e Fisiologia

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

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 mu m (p<0.001; -1.18 +/- 1.93 mu m/year) in injected eyes and from 79.95 +/- 17.91 to 76.61 +/- 17.97 mu m (p<0.001; -1.07 +/- 0.98 mu m/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; progression; optical coherence tomography; retinal nerve fiber layer thickness