Abstract
PurposeTo evaluate the effects of repeated intravitreal ranibizumab injections on corneal sensitivity, corneal sub-basal nerve plexus (SBNP) and peripapillary retinal nerve fiber layer (RNFL) thickness in patients with neovascular age-related macular degeneration (AMD).MethodsSixty-six eyes of 33 patients who had received unilateral repeated intravitreal ranibizumab injections (0.5 mg/0.05 ml) for the treatment of AMD and 25 eyes of 25 healthy subjects were included in the study. Central corneal sensation was measured using the contact Cochet-Bonnet esthesiometer. The laser scanning in vivo corneal confocal microscope was used to determine corneal SBNP parameters. The peripapillary RNFL thickness was assessed with spectral-domain optical coherence tomography. Data obtained from the ranibizumab-injected eyes were compared with those of the fellow non-treated eyes and the eyes of the healthy control subjects.ResultsThe mean number of ranibizumab injections per eye was 8.9±5.0 (range 3–20). There were no statistically significant differences in the central corneal sensitivity threshold and corneal SBNP parameters between the ranibizumab-injected eyes and the fellow untreated eyes or between those with neovascular AMD and the healthy control group (P>0.05 for all). The average peripapillary RNFL thickness of the treated eyes did not differ significantly to the fellow eyes (P = 0.237), and the eyes of healthy control subjects (P = 0.918). There were no significant correlations between the number of ranibizumab injections and any of the study parameters.ConclusionsMultiple intravitreal injections of ranibizumab seem to have no harmful effects on corneal sensitivity, innervation and peripapillary RNFL thickness in patients with AMD.
Highlights
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness among elderly people in developed countries [1]
There were no significant correlations between the number of ranibizumab injections and any of the study parameters
Multiple intravitreal injections of ranibizumab seem to have no harmful effects on corneal sensitivity, innervation and peripapillary retinal nerve fiber layer (RNFL) thickness in patients with AMD
Summary
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness among elderly people in developed countries [1]. The age-related changes that stimulate pathologic neovascularization are not completely understood, vascular endothelial growth factor A (VEGF-A), which is a key regulator of angiogenesis and vascular permeability, has been implicated as an important factor in the pathogenesis of AMD [3,4]. Ranibizumab, a recombinant humanized monoclonal antibody antigen-binding fragment that neutralizes all known active forms of VEGF-A, has widely been used via intravitreal injection for the treatment of neovascular AMD [5]. Experimental studies have documented that VEGF is expressed by neurons mediating neuroprotective and neurotrophic activities [7,8,9], and neutralization of VEGF, using anti-VEGF antibodies impairs regeneration of the corneal sub-basal nerve plexus (SBNP) in injured mice corneas [10].
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