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Heather B. Seith, Ronald E. Frenkel; Evaluation of Nerve Fiber Layer by SD-OCT in Patients Treated Monocularly with Anti-VEGF Intravitreal Injections for AMD. Invest. Ophthalmol. Vis. Sci. 2012;53(14):876.
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To determine if repeated intravitreal injections and the associated intraocular pressure spikes result in a decrease in thickness of the NFL in macular degeneration patients by comparing treated vs. untreated fellow eyes. Intravitreal injections of anti-VEGF medications have become the standard of care for exudative AMD. IOP spikes are a risk factor for progression of glaucoma. Intravitreal injection of anti-VEGF agents is commonly followed by a transient increase in intraocular pressure. Some physicians are considering giving lower volumes or decreasing the frequency of injections of anti-VEGF agents because of concerns that they may be causing glaucomatous damage.
In this retrospective study we used SD-OCT to assess differences in the nerve fiber layers between treated and untreated eyes of twenty patients who had been treated with anti-VEGF intravitreal injections monocularly for macular degeneration. Patients had received between 10 and 42 (mean 18.2 +/- 8.8) intravitreal injections over a period of two years prior to OCT NFL analysis. OCT NFL analysis was performed and the measurements recorded for each eye of each patient. A paired t-test was performed to determine if there was any significant difference in NFL thickness between treated and untreated eyes.
The mean NFL thickness for all treated eyes was 81.75 +/- 15.9, and for untreated eyes 82.55 +/- 14.4, p= 0.63. IOP spikes associated with a mean of 18 intravitreal injections are insufficient to cause NFL decreases when measured by SD-OCT.
This study did not find any significant difference between treated and untreated eyes in NFL thickness over a two year time span. This does not exclude that these IOP spikes may cause damage when looked at over a longer term. Further prospective studies with larger numbers of patients and longer periods of follow up will be necessary to finally determine if there is any optic nerve damage incurred with repeated injections of anti-VEGF agents over time. In the meantime, the dose and frequency of these treatments should not be altered based on concerns that glaucoma may ensue.
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