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  • Intravitreal Injections and Dry Eye

    By Jean Shaw
    Selected by Russell N. Van Gelder, MD, PhD
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    Journal Highlights

    Ophthalmology, May 2023

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    What effects do serial intravitreal injec­tions of anti-VEGF agents have on the ocular surface of patients with age-related macular degeneration (AMD)? Malmin et al. set out to investigate this issue. Surprisingly, they found that repeated intravitreal injections, along with preinjection application of povidone-iodine, was associated with reduced meibomian gland (MG) loss, increased tear volume, and reduced signs of inflammation, suggesting that the regimen may have a beneficial effect on the ocular surface.

    For this retrospective study, the researchers evaluated 90 patients with neovascular AMD (age range, 54-95 years). The participants received unilateral injections with anti-VEGF drugs, and their untreated fellow eyes served as controls. They all received povidone-iodine prior to the injections. Tear film and ocular surface examina­tions took place on a single occasion at a minimum of four weeks after an injection. Main outcome measures were MG atrophy, tear meniscus height (TMH), bulbar redness (BR) score, noninvasive tear breakup time, tear film osmolarity, Schirmer test, corneal stain­ing, fluorescein tear film breakup time, MG expressibility, and meibum quality.

    The median number of intravit­real injections in treated eyes was 19.5 (range, 2-132 injections). Ocular surface outcomes were as follows:

    • MG loss. In the upper eyelid, mean MG loss was 19.1% ± 11.3% in treated eyes and 25.5% ± 14.6% in untreated fellow eyes. For the lower eyelid, median MG loss was 17.4% in treated eyes and 24.5% in fellow eyes.
    • Bulbar redness. The mean BR was 1.32 ± .46 in treated eyes and 1.44 ± .45 in fellow eyes.
    • Tear meniscus height. Median TMH was .36 in treated eyes and .32 in fellow eyes.
    • Other measures. There were no significant differences between treated and fellow eyes with regard to the other measures.

    The underlying mechanism con­tributing to these results may be the povidone-iodine protocol, which has antibacterial properties that can be pro­tective against ocular surface damage associated with eyelid margin diseases, the researchers noted. Alternatively, the anti-inflammatory role of VEGF inhi­bition may have a positive effect on dry eye, they wrote, and they encouraged further research.

    The original article can be found here.