Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Ophthalmol Retina. 2021 Jul;5(7):648-654. doi: 10.1016/j.oret.2020.10.004. Epub 2020 Oct 10.
To determine if multiple intravitreal injections of vascular endothelial growth factor (VEGF) inhibitors for unilateral exudative age-related macular degeneration (eAMD) are associated with thinning of the retinal nerve fiber layer (RNFL), we compared RNFL thickness measurements from the injected eye with that of the fellow eye with nonexudative age-related macular degeneration (neAMD).
Retrospective, cross-sectional study.
Patients undergoing anti-VEGF therapy for unilateral eAMD.
Patients receiving anti-VEGF therapy secondary to eAMD in 1 eye with neAMD in their fellow eye were identified. Patients with a known diagnosis of glaucoma were excluded. Spectral domain OCT measurements of the peripapillary RNFL thickness from both eyes were performed and compared. The differences in the RNFL thickness measurements between eyes were correlated with the number of injections and the duration of therapy.
Correlation between the number of anti-VEGF injections and peripapillary RNFL thinning.
A total of 108 eyes of 54 patients were evaluated in this study. The average peripapillary RNFL thickness measurements of the injected eye and fellow eye were 87.3 ± 9.6 μm and 89.0 ± 7.5 μm, respectively (P = 0.055). The RNFL thickness difference (fellow eye minus injected eye) was significantly correlated with the number of injections (r = 0.40, P = 0.002) and months of injections (r = 0.38, P = 0.005). The relationship between the difference in the RNFL thickness and the number of injections had a nonlinear dose-response relationship that became apparent after approximately 30 injections and 50 months of injections.
The difference in RNFL thickness measurements between injected eyes and uninjected fellow eyes was largely within the reported normal limits for interocular differences between healthy eyes. Nevertheless, there was a dose-response relationship between RNFL thinning and number of injections among patients receiving a greater number of injections, suggesting that anti-VEGF injections may have a modest effect on the RNFL thickness after several years of therapy in eyes requiring more anti-VEGF injections; however, we cannot exclude that the RNFL thinning may be secondary to active age-related macular degeneration (AMD) disease progression in both eyes.
为了确定对于单侧渗出性年龄相关性黄斑变性（eAMD）进行多次玻璃体内血管内皮生长因子（VEGF）抑制剂注射是否与视网膜神经纤维层（RNFL）变薄有关，我们比较了接受治疗的眼与对侧无渗出性年龄相关性黄斑变性（neAMD）眼的 RNFL 厚度测量值。
回顾性、横断面研究。
接受抗 VEGF 治疗的单侧 eAMD 患者。
确定了 1 只眼接受抗 VEGF 治疗的患者，对侧眼患有 neAMD。排除已知患有青光眼的患者。对双眼进行了周边视网膜神经纤维层厚度的光谱域 OCT 测量，并进行了比较。眼间 RNFL 厚度测量值的差异与注射次数和治疗持续时间相关。
抗 VEGF 注射次数与周边 RNFL 变薄之间的相关性。
本研究共评估了 54 例患者的 108 只眼。接受治疗的眼和对侧眼的平均周边 RNFL 厚度测量值分别为 87.3±9.6 μm 和 89.0±7.5 μm（P=0.055）。RNFL 厚度差值（对侧眼减去接受治疗的眼）与注射次数（r=0.40，P=0.002）和注射月数（r=0.38，P=0.005）显著相关。RNFL 厚度差异与注射次数之间存在非线性剂量反应关系，在接受 30 多次注射和 50 多个月的注射后变得明显。
接受治疗的眼与未接受治疗的对侧眼的 RNFL 厚度测量值差异在健康眼的眼间差异的报道正常值范围内。然而，在接受更多注射的患者中，RNFL 变薄与注射次数之间存在剂量反应关系，这表明在需要更多抗 VEGF 注射的眼接受数年治疗后，抗 VEGF 注射可能对 RNFL 厚度有一定影响；但是，我们不能排除 RNFL 变薄可能是由于双眼的活动性年龄相关性黄斑变性（AMD）疾病进展所致。
