Associations between Serial Intravitreal Injections and Dry Eye

Purpose To investigate the effects of serial intravitreal injections (IVIs) on the ocular surface and meibomian glands (MGs) in patients treated with anti-vascular endothelial growth factor (anti-VEGF) for neovascular age-related macular degeneration (nAMD). Design Retrospective, controlled, observational study. Participants Patients with nAMD receiving unilateral IVIs with anti-VEGF agents. The fellow eye was used as control. Methods Tear film and ocular surface examinations were performed on a single occasion at a minimum of 4 weeks after IVI. A pre-IVI asepsis protocol with povidone-iodine (PVP-I) was applied. Main Outcome Measures Upper and lower MG loss, tear meniscus height (TMH), bulbar redness (BR) score, noninvasive tear break-up time (NIBUT), tear film osmolarity (TOsm), Schirmer test, corneal staining, fluorescein tear film break-up time (TBUT), meibomian gland expressibility (ME), and meibum quality. Results Ninety patients with a mean age of 77.5 years (standard deviation [SD], 8.4; range 54–95) were included. The median number of IVIs in treated eyes was 19.5 (range, 2–132). Mean MG loss in the upper eyelid was 19.1% (SD, 11.3) in treated eyes and 25.5% (SD, 14.6) in untreated fellow eyes (P = 0.001). For the lower eyelid, median MG loss was 17.4% (interquartile range [IQR], 9.4–29.9) in treated eyes and 24.5% (IQR, 14.2–35.2) in fellow eyes (P < 0.001). Mean BR was 1.32 (SD, 0.46) in treated eyes versus 1.44 (SD, 0.45) in fellow eyes (P = 0.017). Median TMH was 0.36 mm (IQR, 0.28–0.52) in treated eyes and 0.32 mm (IQR, 0.24–0.49) in fellow eyes (P = 0.02). There were no differences between treated and fellow eyes regarding NIBUT, TOsm, Schirmer test, corneal staining, fluorescein TBUT, ME, or meibum quality. Conclusions Repeated IVIs with anti-VEGF with preoperative PVP-I application was associated with reduced MG loss, increased tear volume, and reduced signs of inflammation compared with fellow nontreated eyes in patients with nAMD. This regimen may thus have a beneficial effect on the ocular surface.publishedVersio

Drusenoid pigment epithelial detachment volume is associated with a decrease in best‐corrected visual acuity and central retinal thickness: the Norwegian Pigment Epithelial Detachment Study (NORPED) report no. 1

Purpose To investigate the association of drusenoid pigment epithelial detachment (DPED) volume and change in best‐corrected visual acuity (BCVA) and central retinal thickness (CRT) during the growth phase of large DPEDs. Methods Patients from an ongoing prospective observational study, the Norwegian Pigment Epithelial Detachment Study (NORPED), with 1 year of follow‐up and DPEDs ≥1000 µm in diameter, examined with the Heidelberg Spectralis HRA‐OCT were included. Patients with DPEDs in the regression phase were excluded. Multicolour, near‐infrared reflectance, optical coherence tomography (OCT) and OCT angiography images were obtained every 6 months. Fluorescein angiography and indocyanine green angiography were performed at baseline and yearly to exclude choroidal neovascularization (CNV). Results Forty‐four patients and 66 eyes were included. In the statistical model for BCVA, every 1.0 mm3 increase in DPED volume led to a decrease in BCVA of 4.0 ETDRS letters (95% CI, −7.0 to −1.0, p = 0.008). A decrease in BCVA was significantly associated with older patient age, the presence of acquired vitelliform lesions and subfoveal location of the DPEDs. In the model for CRT, every 1.0 mm3 increase in DPED volume led to a decrease in CRT of 26.7 µm (95% CI, −44.4 to −9.0, p = 0.003). Two eyes had progression of geographic atrophy and none developed CNV. Conclusion The increasing volume of DPEDs during the growth phase is associated with a decrease in BCVA and CRT. The subfoveal location of DPEDs and the presence of acquired vitelliform lesions appear to be associated with a further reduction in BCVA

Drusenoid pigment epithelial detachment volume is associated with a decrease in best-corrected visual acuity and central retinal thickness: the Norwegian Pigment Epithelial Detachment Study (NORPED) report no. 1

Purpose To investigate the association of drusenoid pigment epithelial detachment (DPED) volume and change in best‐corrected visual acuity (BCVA) and central retinal thickness (CRT) during the growth phase of large DPEDs. Methods Patients from an ongoing prospective observational study, the Norwegian Pigment Epithelial Detachment Study (NORPED), with 1 year of follow‐up and DPEDs ≥1000 µm in diameter, examined with the Heidelberg Spectralis HRA‐OCT were included. Patients with DPEDs in the regression phase were excluded. Multicolour, near‐infrared reflectance, optical coherence tomography (OCT) and OCT angiography images were obtained every 6 months. Fluorescein angiography and indocyanine green angiography were performed at baseline and yearly to exclude choroidal neovascularization (CNV). Results Forty‐four patients and 66 eyes were included. In the statistical model for BCVA, every 1.0 mm3 increase in DPED volume led to a decrease in BCVA of 4.0 ETDRS letters (95% CI, −7.0 to −1.0, p = 0.008). A decrease in BCVA was significantly associated with older patient age, the presence of acquired vitelliform lesions and subfoveal location of the DPEDs. In the model for CRT, every 1.0 mm3 increase in DPED volume led to a decrease in CRT of 26.7 µm (95% CI, −44.4 to −9.0, p = 0.003). Two eyes had progression of geographic atrophy and none developed CNV. Conclusion The increasing volume of DPEDs during the growth phase is associated with a decrease in BCVA and CRT. The subfoveal location of DPEDs and the presence of acquired vitelliform lesions appear to be associated with a further reduction in BCVA