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Jonathan Naysan, Tushar Suthar, Ronni Lieberman, Jonathan Jonisch; Effect of an Intravitreal Anti-VEGF Injection on the Dynamics of the Anterior Segment. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6302.
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Intravitreal injections of various pharmacologic agents are now standard of care in a number of retinal vascular diseases. Optical Coherence Tomography (OCT) allows imaging of the anterior segment, specifically the angle structures, anterior chamber, and cornea. This study investigates the effects of a single intravitreal anti-VEGF injection on the dynamics of the anterior segment structures.
A chart review was done looking for patients who had received a single intravitreal injection of either Lucentis ® (ranibizumab), Avastin ® (bevacizumab), or Eylea ® (aflibercept), in addition to anterior segment imaging of the same eye. Nine eyes were identified. Each eye was injected with equal volumes (0.05mL). Using the Visante Optical Coherence Tomography (OCT) machine, imaging of the anterior segment was performed 5 minutes before and after the injection. The angle opening distance (AOD) and trabeculo-iris space area (TISA) at 500µm and 750µm anterior to the scleral spur were measured both pre and post injection. The scleral spur angle (SSA), and central corneal thickness (CCT) were also obtained. None of the patients carried the diagnosis of glaucoma or anterior segment anomalies.
Of the 9 patients, 7 were injected into the left eye and 2 in the right. Six were injected with Lucentis, 2 with Avastin, and 1 with Eylea. The mean pre injection AOD(500µm) was 0.385mm and post injection 0.369mm with a mean difference of -0.0165mm (-4.2%, p=0.19) after injection. The mean pre injection AOD(750µm) was 0.542mm and post injection 0.536mm with a mean difference of -0.0064mm (-1.2%, p=0.35). The TISA(500µm) mean pre injection was 0.145mm2 and post injection was 0.133mm2 with a mean difference of -0.012mm2 (-8.3%, p=0.029). The TISA(750µm) mean pre injection was 0.26mm2 and post injection was 0.133mm2 with a mean difference of -0.13mm2 (-49%, p< 0.001). The SSA decreased by an average of 2.2% (p=0.28). The CCT showed a 0.2% increase after injection (p=0.32).
A statistically significant decrease in the TISA at both 500µm and 750µm after an anti-VEGF intravitreal injection is seen. While the AOD and SSA both decreased overall, they did not reach statistical significance. Intravitreal injections may have an effect on the dynamics of the anterior segment, specifically the angle structures. Further studies are warranted on the effects of intravitreal injections on the angle dynamics.
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