Do repeated anti-VEGF intravitreal injections accelerate glaucomatous progression?

There is no apparent association between repeated intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) agents in eyes with glaucoma spectrum diseases (GSD) and an acceleration of glaucomatous progression, according to a study.

The study included 68 eyes from 34 patients with bilateral and similar GSD. One eye from each patient received a minimum of 8 IVIs, while the fellow eye remained untreated during the study period. To assess outcomes, retinal nerve fiber layer thickness (RNFL) measurements were obtained by spectral-domain optical coherence tomography (SD-OCT) at least 12 months apart.

Over an average follow-up of 3.66 years and a mean of 25.12 IVI, researchers observed a significant decrease in RNFL thickness in both injected and uninjected eyes. The absolute RNFL thickness change was -1.18 μm/year in injected eyes and -1.07 μm/year in uninjected eyes. However, a multivariable linear mixed model revealed that only higher baseline RNFL thickness significantly predicted greater absolute RNFL thickness loss in injected eyes.

The study found no significant differences in absolute RNFL thickness variation, RNFL rate, or intraocular pressure (IOP) variation between paired injected and uninjected eyes. Despite the repeated IVIs, absolute IOP variation remained comparable in both groups.

The proportion of eyes receiving glaucoma medical treatment increased significantly in both injected and uninjected eyes, along with a rise in the number of glaucoma medications in both groups.

Reference
Vilares-Morgado R, Correia V, Ferreira AM, et al. Effect of Repeated Intravitreal Injections in Glaucoma Spectrum Diseases. Clin Ophthalmol. 2023;17:3613-3627. doi: 10.2147/OPTH.S441500. PMID: 38026596; PMCID: PMC10676727.