Associations between Serial Intravitreal Injections and Dry Eye

Agni Malmin; Vilde M Thomseth; Per T Førland; Ayyad Z Khan; Hanne B Hetland; Xiangjun Chen; Inga-Britt K Haugen; Tor P Utheim; Vegard A Forsaa

doi:10.1016/j.ophtha.2023.01.009

Associations between Serial Intravitreal Injections and Dry Eye

Ophthalmology. 2023 May;130(5):509-515. doi: 10.1016/j.ophtha.2023.01.009. Epub 2023 Jan 21.

Authors

Agni Malmin¹, Vilde M Thomseth², Per T Førland³, Ayyad Z Khan⁴, Hanne B Hetland⁵, Xiangjun Chen⁶, Inga-Britt K Haugen⁷, Tor P Utheim⁸, Vegard A Forsaa²

Affiliations

¹ Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway. Electronic address: [email protected].
² Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway; Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.
³ Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway.
⁴ Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.
⁵ Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway.
⁶ Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; Department of Ophthalmology, Hospital of Southern Norway, Arendal, Norway; Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway.
⁷ Norwegian Association of the Blind and Partially Sighted, Oslo, Norway.
⁸ Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; Department of Ophthalmology, Hospital of Southern Norway, Arendal, Norway; Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway.

PMID: 36693594
DOI: 10.1016/j.ophtha.2023.01.009

Abstract

Purpose: To investigate the effects of serial intravitreal injections (IVIs) on the ocular surface and meibomian glands (MGs) in patients treated with anti-vascular endothelial growth factor (anti-VEGF) for neovascular age-related macular degeneration (nAMD).

Design: Retrospective, controlled, observational study.

Participants: Patients with nAMD receiving unilateral IVIs with anti-VEGF agents. The fellow eye was used as control.

Methods: Tear film and ocular surface examinations were performed on a single occasion at a minimum of 4 weeks after IVI. A pre-IVI asepsis protocol with povidone-iodine (PVP-I) was applied.

Main outcome measures: Upper and lower MG loss, tear meniscus height (TMH), bulbar redness (BR) score, noninvasive tear break-up time (NIBUT), tear film osmolarity (TOsm), Schirmer test, corneal staining, fluorescein tear film break-up time (TBUT), meibomian gland expressibility (ME), and meibum quality.

Results: Ninety patients with a mean age of 77.5 years (standard deviation [SD], 8.4; range 54-95) were included. The median number of IVIs in treated eyes was 19.5 (range, 2-132). Mean MG loss in the upper eyelid was 19.1% (SD, 11.3) in treated eyes and 25.5% (SD, 14.6) in untreated fellow eyes (P = 0.001). For the lower eyelid, median MG loss was 17.4% (interquartile range [IQR], 9.4-29.9) in treated eyes and 24.5% (IQR, 14.2-35.2) in fellow eyes (P < 0.001). Mean BR was 1.32 (SD, 0.46) in treated eyes versus 1.44 (SD, 0.45) in fellow eyes (P = 0.017). Median TMH was 0.36 mm (IQR, 0.28-0.52) in treated eyes and 0.32 mm (IQR, 0.24-0.49) in fellow eyes (P = 0.02). There were no differences between treated and fellow eyes regarding NIBUT, TOsm, Schirmer test, corneal staining, fluorescein TBUT, ME, or meibum quality.

Conclusions: Repeated IVIs with anti-VEGF with preoperative PVP-I application was associated with reduced MG loss, increased tear volume, and reduced signs of inflammation compared with fellow nontreated eyes in patients with nAMD. This regimen may thus have a beneficial effect on the ocular surface.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.

Keywords: Anti-VEGF; Dry eye disease; Intravitreal injections; Meibomian glands; Povidone iodine.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Dry Eye Syndromes* / diagnosis
Dry Eye Syndromes* / drug therapy
Dry Eye Syndromes* / metabolism
Fluoresceins / metabolism
Humans
Intravitreal Injections
Meibomian Glands / metabolism
Povidone-Iodine*
Retrospective Studies
Tears / metabolism

Substances

Povidone-Iodine
Fluoresceins