Associations between Serial Intravitreal Injections and Dry Eye

Abstract

To investigate the effects of serial intravitreal injections (IVI) on the ocular surface and meibomian glands (MG) in patients treated with anti-vascular endothelial growth factor (anti-VEGF) for neovascular age-related macular degeneration (nAMD). Retrospective controlled observational study. Patients with nAMD receiving unilateral IVI with anti-VEGF agents. The fellow eye was used as control. Tear film and ocular surface examinations were performed on a single occasion at a minimum of four weeks after IVI. A pre-IVI asepsis protocol with povidone-iodine was applied. Upper and lower MG loss, tear meniscus height (TMH), bulbar redness score (BR), non-invasive 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 (MQ). Ninety patients with a mean age of 77.5 years (SD 8.4; range 54-95) were included. The median number of IVI 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 (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 (IQR 0.28-0.52) mm in treated eyes and 0.32 (IQR 0.24-0.49) mm in fellow eyes (P=0.02). There were no differences between treated and fellow eyes regarding NIBUT, TOsm, Schirmer test, corneal staining, fluorescein TBUT, meibomian gland expressibility ME or MQ. Repeated IVI with anti-VEGF with preoperative povidone-iodine application was associated with reduced meibomian gland loss, increased tear volume and reduced signs of inflammation compared to fellow non-treated eyes in patients with nAMD. This regimen may thus have a beneficial effect on the ocular surface.