Abstract
Purpose To assess the effect of repeated intravitreal ranibizumab injections (RI) and aflibercept injections (AI) on the corneal endothelium and central corneal thickness (CCT) in patients with age-related macular degeneration (AMD). Materials and Methods In the retrospective study, 110 eyes of 106 patients, aged 52 to 93 years, were analyzed. Fifty eyes were treated only with RI (I group), and 60 eyes were treated only with AI (II group). Every patient received one intravitreal injection of 0.5 mg of ranibizumab once a month or 2 mg of aflibercept for 3 subsequent months. Each patient received only 3 injections during the whole observation period. Corneal analysis was obtained with the specular microscope. Examinations were performed before initial treatment, after each injection, and 6 months after the first injection. Analysis included corneal endothelial cell density (ECD), hexagonal cell percentage (% Hex), coefficient of variation (CoV), and CCT. Results There was a statistically significant ECD loss, regardless of the type of the anti-VEGF agent. The mean ECD value in the I group was 2397 ± 459 cells/mm2 before RI, 2389 ± 459 cells/mm2 after the first RI, 2386 ± 467 cells/mm2 after the second RI, 2378 ± 475 cells/mm2 after the third RI, and 2357 ± 460 cells/mm2 6 months after the first RI. The mean ECD value in the II group was 2448 ± 493 cells/mm2 before treatment, 2456 ± 498 cells/mm2 after the first AI, 2426 ± 496 cells/mm2 after the second AI, 2402 ± 488 cells/mm2 after the third AI, and 2348 ± 473 cells/mm2 6 months after the first AI. In comparison with the group treated with RI, the group treated with AI presented a greater ECD loss at each measuring point. The percentage of hexagonal cells was decreased in both groups. There was a slight increase in polymegathism in both treated groups. Ranibizumab proved to cause a small increase in CCT, while CCT remained unchanged in the aflibercept group. Conclusions Repeated intravitreal injections of 0.5 mg of ranibizumab or 2 mg of aflibercept can influence the morphology of the corneal endothelium but not CCT.
Highlights
Age-related macular degeneration (AMD) is one of the most common causes of permanent visual impairment and blindness in developed countries among people over 60 years of age
Analysis of endothelial cell density (ECD) before, during, and after the treatment of age-related macular degeneration (AMD) with ranibizumab injections is presented in Table 1. e mean ECD before RI was 2397.14 ± 459.33 cells/mm2, and it was significantly lower after each RI. e loss of the corneal endothelium cells was 0.3% after the first RI (Wilcoxon test, p 0.022), 0.5% after the second RI (Wilcoxon test, p 0.041), 0.8% after the third RI (Wilcoxon test, p 0.0007), and 1.7% 6 months after the first RI (Wilcoxon test, p 0.000019) (Table 2)
In patients treated with aflibercept injections, ECD before the therapy was 2488.32 ± 492.88 cells/mm2, and to RI, it was significantly reduced after each AI (Table 3). e loss of the corneal endothelium cells was 1.3% after the first AI (Wilcoxon test, p < 0.0001), 2.5% after the second AI (Wilcoxon test, p < 0.0001), 3.5% after the third AI (Wilcoxon test, p < 0.0001), and 5.6% 6 months after the first RI (Wilcoxon test, p < 0.0001) (Table 2)
Summary
Age-related macular degeneration (AMD) is one of the most common causes of permanent visual impairment and blindness in developed countries among people over 60 years of age. It is estimated that the number of people with AMD worldwide will be 288 million in 2040 [1]. Intravitreal administration of vascular endothelial growth factor antagonists (anti-VEGF), mainly ranibizumab and aflibercept, became the gold standard of modern wet AMD therapy [2, 3]. Ranibizumab (Lucentis, Genentech, South San Francisco, CA), a humanized monoclonal antibody fragment, was the first anti-VEGF agent shown to improve visual acuity in patients with wet AMD, and it was approved for use in wet AMD in Europe in 2007 [4]. Intravitreal aflibercept (IVTAFL) is used in wet AMD in Europe since 2012. Several clinical studies confirmed high safety profile of anti-VEGF
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