The effect of intravitreal injections on dry eye, and proposed management strategies

Laude, Augustinus; Lim, Jimmy; Srinagesh, Vishwanath; Tong, Louis

doi:10.2147/opth.s136500

Cited by 14 publications

(9 citation statements)

References 28 publications

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“…VEGF levels were reported to be elevated in the blood of diabetic patients, playing a key role in diabetes-related morbidity such as diabetic retinopathy, age-related macular degeneration, and a variety of cardiovascular diseases. In ocular surface diseases such as DED, VEGF is known as an inflammatory marker that impairs the surface epithelium of the eye ( 29 ). However, VEGF is also recognized as a pleiotropic factor with a broad effect on endothelial, neuronal, and glial behaviors ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

The association between altered intestinal microbiome, impaired systemic and ocular surface immunity, and impaired wound healing response after corneal alkaline-chemical injury in diabetic mice

Shih

Wong

et al. 2023

Front. Immunol.

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PurposeWe aim to investigate the effect of sustained hyperglycemia on corneal epithelial wound healing, ocular surface and systemic immune response, and microbiome indices in diabetic mice compared to controls after alkaline chemical injury of the eye.MethodsCorneal alkaline injury was induced in the right eye of Ins2Akita (Akita) mice and wild-type mice. The groups were observed at baseline and subsequently days 0, 3, and 7 after injury. Corneal re-epithelialization was observed under slit lamp with fluorescein staining using a cobalt blue light filter. Enucleated cornea specimens were compared at baseline and after injury for changes in cornea thickness under hematoxylin and eosin staining. Tear cytokine and growth factor levels were measured using protein microarray assay and compared between groups and time points. Flow cytometry was conducted on peripheral blood and ocular surface samples to determine CD3+CD4+ cell count. Fecal samples were collected, and gut microbiota composition and diversity pattern were measured using shotgun sequencing.ResultsAkita mice had significantly delayed corneal wound healing compared to controls. This was associated with a reduction in tear levels of vascular endothelial growth factor A, angiopoietin 2, and insulin growth factor 1 on days 0, 3, and 7 after injury. Furthermore, there was a distinct lack of upregulation of peripheral blood and ocular surface CD3+CD4+ cell counts in response to injury in Akita mice compared to controls. This was associated with a reduction in intestinal microbiome diversity indices in Akita mice compared to controls after injury. Specifically, there was a lower abundance of Firmicutes bacterium M10-2 in Akita mice compared to controls after injury.ConclusionIn diabetic mice, impaired cornea wound healing was associated with an inability to mount systemic and local immune response to ocular chemical injury. Baseline and post-injury differences in intestinal microbial diversity and abundance patterns between diabetic mice and controls may potentially play a role in this altered response.

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Section: Discussionmentioning

confidence: 99%

The association between altered intestinal microbiome, impaired systemic and ocular surface immunity, and impaired wound healing response after corneal alkaline-chemical injury in diabetic mice

Shih

Wong

et al. 2023

Front. Immunol.

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“…4 Povidone-iodine and antibiotics were blamed for the ocular surface effects after repeated intravitreal injections. 15 Intravitreal injection of anti-VEGF agents was not supposed to cause harm on meibomian glands. On the contrary, direct anti-VEGF injections into meibomian glands were reported as a treatment alternative.…”

Section: Discussionmentioning

confidence: 99%

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

Polat¹,

Çetinkaya²,

Evereklioğlu³

et al. 2021

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

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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.

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“…These ocular surgeries are associated with DED in previous studies, with the incidence of post-cataract DED of 9–32% ( 21 , 22 ). Accumulating evidence also demonstrated that IVI was associated with deterioration of ocular surface health ( 20 , 23 ); TPPV contributed to the development of signs and symptoms of DED, and PRP induced the decrease in tear break-up time and Schirmer test value ( 24 ).…”

Section: Introductionmentioning

confidence: 99%

Dry eye disease in patients with type II diabetes mellitus: A retrospective, population-based cohort study in Taiwan

et al. 2022

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PurposeTo investigate the risk and protective factors of dry eye disease (DED) in patients with type II diabetes mellitus (DM).DesignA retrospective cohort study using Chang- Gung research database collecting data from 2005 to 2020.MethodsPatients with type II DM were included, and those with previous ocular diseases were excluded. Ten thousand twenty nine developed DED (DED group), and 142,491 didn't (non-DED group). The possible risk and protective factors were compared and analyzed using the logistic regression model.ResultsA majority of the DED group were female with significantly higher initial and average glycated hemoglobin levels, and higher incidence of diabetic neuropathy and retinopathy. In conditional logistic regression model, advanced age was a risk factor. After adjusting for sex, age, and DM duration; average glycated hemoglobin level, diabetic neuropathy, retinopathy, and nephropathy with eGFR 30 ~ 59 and intravitreal injection, vitrectomy, pan-retinal photocoagulation, and cataract surgery were contributing factors of DED. Considering antihyperglycemic agents, DPP4 inhibitor, SGLT2 inhibitor, GLP-1 agonist, and insulin monotherapy and dual medications combining any two of the aforementioned agents were protective factors against DED compared with metformin alone. In the monotherapy group, SLGT2 inhibitor had the lowest odds ratio, followed by GLP1 agonist, DPP4 inhibitor, and insulin.ConclusionsDED in patients with DM is associated with female sex, advanced age, poor diabetic control, microvascular complications and receiving ocular procedures. GLP-1 agonist, SGLT-2 inhibitor, DPP4 inhibitor, and insulin are superior to metformin alone in preventing DM-related DED. A prospective randomized control trial is warranted to clarify our results.

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The effect of intravitreal injections on dry eye, and proposed management strategies

Cited by 14 publications

References 28 publications

The association between altered intestinal microbiome, impaired systemic and ocular surface immunity, and impaired wound healing response after corneal alkaline-chemical injury in diabetic mice

The association between altered intestinal microbiome, impaired systemic and ocular surface immunity, and impaired wound healing response after corneal alkaline-chemical injury in diabetic mice

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

Dry eye disease in patients with type II diabetes mellitus: A retrospective, population-based cohort study in Taiwan

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