The Effect of Multiple Injections of Ranibizumab on Retinal Nerve Fiber Layer Thickness in Patients with Age-Related Macular Degeneration

Demirel, Sibel; Batıoğlu, Figen; Özmert, Emin; Erenler, Feyza

doi:10.3109/02713683.2014.917190

Cited by 34 publications

(29 citation statements)

References 25 publications

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“…The study with the longest follow-up in the literature analyzed the changes in peripapillary nerve fibers only after a mean 13.8 ± 3.8 IVIs, which corresponds to slightly more than 1 year of monthly IVIs. This study demonstrated no statistically significant difference compared to the initial data [14]. …”

Section: Discussioncontrasting

confidence: 56%

Intraocular Pressure Spikes after Aflibercept Intravitreal Injections

et al. 2016

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The objective of this study was to assess the intraocular pressure (IOP) as well as the anatomical modifications of the anterior segment following an aflibercept injection. Patients underwent an aflibercept intravitreal injection (IVI) (0.05 ml) with a 30.5-gauge needle and an antireflux system. IOP was assessed before injection (T0), immediately after (T1), and 5 min (T5), 15 min (T15), and 45 min (T45) after the IVI. Before the IVI and immediately after the T1 measurement, a PENTACAM® acquisition was used to evaluate the anterior chamber parameters (anterior chamber volume, depth and measure of the iridocorneal angle). At T0, IOP was 12.9 ± 1.3 mm Hg. IOP significantly increased after IVI (42.7 ± 3 mm Hg, p < 0.001). IOP returned to baseline at T45 (13.0 ± 1.2 mm Hg, p = 0.877). Anterior chamber volume decreased after IVI (160.6 vs. 168.3 mm³, p = 0.002). No significant changes were found for iridocorneal angle and anterior chamber depth. Aflibercept IVI causes an acute increase in IOP over a short period without iridocorneal angle closure.

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Section: Discussioncontrasting

confidence: 56%

Intraocular Pressure Spikes after Aflibercept Intravitreal Injections

et al. 2016

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“…However, no significant change in RNFL thickness was observed comparing the initial visit to the Month 6 visit and the last follow-up visit in our study. Our result was consistent with previous studies focusing on anti-VEGF-A agents56. The decrease in RNFL thickness with increasing age is approximately 0.26 μm per year; therefore, the effect of a natural decrease in RNFL thickness during the follow-up period was negligible19.…”

Section: Discussionsupporting

confidence: 92%

“…According to the latest meta-analysis, no association was observed between anti-VEGF injections and RNFL thickness changes3. However, those pooled studies mainly focused on ranibizumab (Lucentis; Genentech, Inc., South San Francisco, CA, USA) and bevacizumab (Avastin; Genentech, Inc.)456, which are monoclonal antibodies against VEGF-A7. Information about RNFL changes after other anti-VEGF injections is limited.…”

mentioning

confidence: 99%

Changes in Retinal Nerve Fiber Layer Thickness after Multiple Injections of Novel VEGF Decoy Receptor Conbercept for Various Retinal Diseases

Zhang

Yang

Jin

et al. 2016

Sci Rep

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Conbercept is a recombinant fusion protein with high affinity for all vascular endothelial growth factor isoforms and placental growth factor. The repeated intravitreal injection of conbercept may cause intraocular pressure (IOP) fluctuations and long-term suppression of neurotrophic cytokines, which could lead to retinal nerve fiber layer (RNFL) damage. This retrospective fellow-eye controlled study included 98 eyes of 49 patients. The changes in IOP and RNFL thickness as well as the correlation between RNFL changes and associated factors were evaluated. The IOP value between the baseline and the last follow-up visit in the injection group and the IOP value of the last follow-up visit between the injection and non-injection groups were not significantly different (p = 0.452 and 0.476, respectively). The global average thickness of the RNFL (μm) in the injection group decreased from 108.9 to 106.1; however, the change was not statistically significant (p = 0.118). No significant difference in the average RNFL thickness was observed at the last follow-up visit between the injection and non-injection groups (p = 0.821). The type of disease was the only factor associated with RNFL thickness changes. In conclusion, repeated intravitreal injections with 0.05 mL conbercept revealed an excellent safety profile for RNFL thickness, although short-term IOP changes were observed.

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“…However, when 2 low-biased, controlled clinical trials were examined separately, repeated anti-VEGF injection was associated with RNFL loss. In comparison to other studies finding no change of RNFL thickness during intravitreal treatment for nAMD, these studies either had a shorter observation time (El-Ashry et al [25] ), a smaller cohort (Demirel et al [15] ), or evaluated RNFL at a different location (Demirel et al [15] ).…”

Section: Discussionmentioning

confidence: 99%

“…In 2014, Demirel et al [15] analyzed global and nasal RNFL thickness with Cirrus OCT in 29 nAMD patients with >10 ranibizumab injections and a mean follow-up of 39 months. This study, like another, found no significant changes of the nasal RNFL [13,15] . A meta-analysis by Shin et al [16] published in April 2016 summarizes the data of 288 eyes in total.…”

Section: Introductionmentioning

confidence: 99%

Retinal Nerve Fiber Loss in Anti-VEGF Therapy for Age-Related Macular Degeneration Can Be Decreased by Anterior Chamber Paracentesis

Enders

Sitnilska²,

Altay³

et al. 2017

Ophthalmologica

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Purpose: To analyze peripapillary retinal nerve fiber layer thickness (RNFLT) change after long-term intravitreal anti-VEGF therapy. Patients with regular anterior chamber paracentesis (ACP) prior to intravitreal injections (IVIs) were compared to those without ACP. Methods: Neovascular age-related macular degeneration (nAMD) was treated in a pro re nata regimen with a minimum of 9 IVIs. RNFLT change was determined in spectral domain optical coherence tomography. Results: In 32 patients without ACP, mean RNFLT loss (-2.16 ± 3.60 µm) was significantly higher than in 44 patients with regular ACP (0.16 ± 3.60; p = 0.029). Both groups were comparable in age (75.0 vs. 76.8 years; p = 0.35), number of IVIs (16.2 vs. 16.6; p = 0.98), and observational time (30.0 vs. 32.3 months; p = 0.32). In patients without ACP, RNFLT loss was higher compared to IVI-naive fellow eyes (p = 0.005), whereas in ACP patients, no difference was detected (p = 0.5). Conclusions: A moderate RNFLT loss is found in nonglaucomatous patients after injection therapy for nAMD. As it is decreased with regular ACP, tight management of intraocular pressure seems advisable.

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The Effect of Multiple Injections of Ranibizumab on Retinal Nerve Fiber Layer Thickness in Patients with Age-Related Macular Degeneration

Abstract: Long-term treatment with anti-vascular endothelial growth factor (VEGF) agents did not lead to significant changes in RNFL thickness in a patient population with wet AMD. Chronic therapy with intravitreal anti-VEGF agents does not appear to adversely affect RNFL thickness.

Cited by 34 publications

References 25 publications

Intraocular Pressure Spikes after Aflibercept Intravitreal Injections

Intraocular Pressure Spikes after Aflibercept Intravitreal Injections

Changes in Retinal Nerve Fiber Layer Thickness after Multiple Injections of Novel VEGF Decoy Receptor Conbercept for Various Retinal Diseases

Retinal Nerve Fiber Loss in Anti-VEGF Therapy for Age-Related Macular Degeneration Can Be Decreased by Anterior Chamber Paracentesis

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