Effect of Repeated Topical Povidone-Iodine and Antibiotic Applications on Meibomian Glands and Ocular Surface Parameters in Patients With Repeated Intravitreal Injections

Abstract

Objectives: To assess whether meibomian glands and ocular surface parameters are affected by repeated topical povidone-iodine and antibiotic applications in patients with repeated intravitreal injections. Methods: Forty-five patients with at least three previous intravitreal injections and 28 healthy controls were included in the study. In the injection group, 21 patients had age-related macular degeneration and 24 patients had diabetic macular edema. For each participant, infrared meibography for the upper and lower eyelids and noninvasive tear break-up time calculation were performed with a corneal topographer. Fluorescein tear break-up time and ocular surface disease index (OSDI) scores were also obtained. Noninvasive tear break-up time, fluorescein tear break-up time, and OSDI scores were recorded for each participant and compared between the injection and control groups. These parameters were also compared as a subgroup analysis between patients with age-related macular degeneration (AMD) and diabetic macular edema (DME). Results: Upper lid meibomian gland loss, lower lid meibomian gland loss ratios, and OSDI scores were significantly higher in the intravitreal injection group compared with the control group (P¼0.004, P,0.001, P,0.001, respectively). Fluorescein tear break-up time and noninvasive tear breakup time were significantly lower in the intravitreal injection group compared with the control group (P,0.001, P,0.001). There was no significant difference between the AMD and DME groups for these parameters. Conclusion: This study showed for the first time that meibomian gland losses were significantly increased by repeated povidone-iodine and antibiotic applications in patients with repeated intravitreal injections. Ocular surface parameters were altered with higher ocular surface symptoms in those patients.

The Inflammatory and Cytological Effect of Repeated Povidone-Iodine Application in Patients Receiving Intravitreal Injections

“…In both studies, TBUT was found to be decreased in eyes that received injections, in line with our results. 10,11 The Oxford ocular surface staining score was examined by Saedon et al 9 in patients with unilateral intravitreal injection and was reported to be significantly higher in the injected eye than in the fellow eye, similar to our study. In another study, Kim et al 26 reported that Rose Bengal staining and corneal fluorescein staining increased after 5% PVI exposure in rabbit eyes, while the Schirmer test was not affected.…”

“…In these limited number of studies, it was commonly observed that patients' quality of life was significantly affected. 9–11,18 In our study, the IVI group had a significantly higher OSDI score of 36.81±19.49 when compared with the control group. Although the OSDI score of the NIVI group was 29.31±17.5, which was lower than that of the IVI group, there was no significant difference between the two groups.…”

“…However, there are limited clinical studies on this procedure, which has been widely used in ophthalmology practice. [9][10][11]19,20 In this study, the injection eyes and fellow eyes of patients with AMD with unilateral injection were compared. Thus, the effect of confounding factors that could affect the results, such as systemic disease, age, and sex, was minimized.…”

“…However, there are limited clinical studies on this procedure, which has been widely used in ophthalmology practice. 9–11,19,20…”

“…Previous studies have shown that the ocular surface is adversely affected, and dry eye complaints develop in patients who underwent repeated PVI because of intravitreal injection. [9][10][11] However, to the best of our knowledge, no previous study has evaluated the inflammatory and cytologic effects of repeated PVI on the ocular surface in patients with intravitreal injection.…”