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  • Study suggests ocular surface protective effects of repeated anti-VEGF injections

    Cornea/External Disease

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    Review of: Associations between serial intravitreal injections and dry eye

    Malmin A, Thomseth V, Førland P, et al. Ophthalmology, May 2023

    A retrospective analysis of patients receiving intravitreal injections for the treatment of neovascular age-related macular degeneration (AMD) appears to show that repeated anti-VEGF injections could have a beneficial impact on the ocular surface, specifically related to dry-eye parameters.

    Study design

    This was a retrospective, observational study of 90 patients treated with unilateral anti-VEGF intravitreal injections for neovascular AMD. Using the untreated eye as a control, the authors examined the tear film and ocular surface at least 4 weeks after the most recent intravitreal injection.

    Outcomes

    The mean age of patients was 77.5 years, and the median number of prior intravitreal injections was 19.5. Meibomian gland loss in both the upper and lower eyelids was significantly lower in the treated eyes (19.1% and 17.4%, respectively) as compared to untreated eyes (25.5% and 24.5%, respectively). Treated eyes also showed significantly less bulbar redness and higher tear meniscus height than untreated eyes.

    Limitations

    The study was limited by its retrospective and observational design, which prevents the authors from identifying any causality between intravitreal injections and dry eye features. There were also possible limitations in image quality when visualizing the meibomian glands due to the software used.

    Clinical significance

    The findings from this study contradict the authors’ prior hypothesis that repeated intravitreal injections are likely to aggravate dry eye disease, instead suggesting that treated eyes may have healthier dry eye parameters than fellow eyes. The authors suggest that there may be beneficial properties of the povidone-iodine preparation used prior to intravitreal injections. Another possible hypothesis is that VEGF medication may have a positive impact on the inflammatory environment of the ocular surface.

    Financial Disclosures: Dr. Zeba Syed discloses financial relationships with Bio-Tissue (Consultant, Lecture Fees/Speakers Bureau); Dompe (Grant Support); Glaukos Corporation (Grant Support).