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R. K. Seth, M. B. Shields, S. Salim, R. A. Adelman; Assessment of Optic Nerve Cup-To-Disc Ratio Changes in Patients Receiving Multiple Intravitreal Injections. Invest. Ophthalmol. Vis. Sci. 2007;48(13):264.
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Intravitreal injection of a pharmacologic agent is known to cause a short-term rise in intraocular pressure (IOP) that then normalizes. Although these IOP changes are short-lived, no study has assessed whether these fluctuations can lead to long-term changes in the optic nerve. This study was designed to investigate whether there were changes in the optic nerve cup-to-disc ratio (c:d) in patients receiving multiple intravitreal injections.
This is a retrospective study, in which a series of patients receiving multiple intravitreal injections were reviewed. Patients with a known history of glaucoma and those receiving triamcinolone acetonide were excluded from the study. Subjects were only included if they had color fundus photographs prior to and following the initiation of at least two intravitreal injections. The fundus photographs were cropped to optic disc images only, which were then randomized and saved with no identifiers, and then independently graded by two glaucoma specialists. In patients who received treatments in only one eye, the fellow eye was used as control.
23 eyes of 21 patients met inclusion criteria. 21/23 eyes (91.3%) received injections with pegaptanib sodium and the remaining 2 eyes received a combination of pegaptanib and ranibizumab injections. The mean change in c:d was -0.012 (95% CI of -0.053 to 0.029) for the treated eyes and -0.006 (95% CI of -0.106 to 0.095) for the control, untreated fellow eyes with no statistically significant difference between the two groups (p=0.90). The mean change in c:d for eyes receiving <= 5 injections (n=9) was 0.003 (95% CI of -0.089 to 0.095) in the treated group and 0.054 (95% CI of -0.033 to 0.142) in the control group with no statistically significant difference among the two (p=0.33). In eyes receiving >5 injections (n=14), the mean change in c:d was -0.021 (95% CI of -0.095 to 0.052) in the treated group and -0.044 (95% CI of -0.207 to 0.119) in the control group with no statistically significant difference among the two (p=0.70).
Our data did not show an increase in the vertical c:d of optic nerves in patients receiving multiple intravitreal injections, suggesting that the short-term IOP fluctuations following intravitreal injections do not adversely increase the optic nerve c:d size.
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