Incidence of Blepharoptosis Following Intravitreal Anti-Vascular Endothelial Growth Factor Injections

Abstract

Purpose : Given conflicting evidence concerning whether intravitreal injections cause ptosis, we performed a retrospective cohort study to determine the incidence of ptosis following intravitreal anti-vascular endothelial growth factor (VEGF) injections. We also compared the rate of ptosis between patients injected with an eyelid speculum and those injected without a speculum, hypothesizing that additional stress placed on the levator palpebrae superiors aponeurosis by the speculum would be associated with an increased ptosis risk.

Methods : A single-center study was conducted on visits between 2008 and 2019. Diagnostic codes using the International Classification of Diseases (ICD-10) were used to identify patients with exudative age-related macular degeneration (AMD) and those who developed ptosis following intravitreal injections. Patients with nonexudative AMD who did not receive intravitreal anti-VEGF injections served as control. The primary outcome was the incidence of ptosis in the injection group compared to the non-injection group. A secondary endpoint was the incidence of ptosis in patients whose anti-VEGF injections were performed with an eyelid speculum as compared to those whose injections were performed without specula. A two-tailed Fisher’s exact test with a significance level of 0.05 was used to compare the ptosis rates.

Results : In total, 3,358 patients met inclusion criteria and were enrolled in the study, including 1,100 exudative AMD patients who received at least one intravitreal anti-VEGF injection and 2,258 nonexudative AMD patients who had not received an intravitreal injection. In the injection group, 18 out of 1100 patients (1.6%) developed ptosis, compared to 52 out of 2258 patients (2.3%) in the non-injection group. This difference was not statistically significant (p= 0.25). Within the injection group, ptosis was mostly bilateral, diagnosed on average 22.4 months following the initial injection, and following more than a one-year injection-free period. In the secondary analysis, 11 out of 537 patients (2.0%) injected without a speculum developed ptosis, compared to 8 out of 444 patients (1.8%) injected with a speculum (p= 0.82).

Conclusions : No statistically significant differences in incidence rates of ptosis were observed. In this analysis, neither intravitreal anti-VEGF injections nor speculum use during injections appears to significantly increase the risk of ptosis.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.