Effect of Repeated Intravitreal Injections in Glaucoma Spectrum Diseases

Figures & data

Figure 1 Flow diagram of study population selection.

Table 1 Characterization of Retinal Disease in the Included Eyes

Parameter	n = 68 eyes
Fellow eye retinal diagnosis	n = 34 eyes
No retinal disease	13 (38.2)
Intermediate AMD	11 (32.4)
Late-stage atrophic AMD	7 (20.6)
Diabetic retinopathy without DME	3 (8.8)
Injected eye retinal diagnosis	n = 34 eyes
Exudative AMD	18 (52.9)
DME	3 (8.8)
Retinal Vein Occlusion	10 (29.4)
Other	3 (8.8)
Number of intravitreal injections during study period	n = 34 eyes
Mean ± SD	25.12 ±14.49
Median (IQR)	23 (15.50)
Range	9–74
Total number of intravitreal injections	n = 34 eyes
Mean ± SD	35.21 ± 21.06
Median (IQR)	28.50 (28.75)
Range	9–84
Drug injected during study period	n = 34 eyes
Bevacizumab	31 (91.2)
Ranibizumab	8 (23.5)
Aflibercept	24 (70.6)
Retinal Laser Treatment	n = 34 eyes
Prior treatment	4 (11.8)
Study time treatment	6 (16.6)
De Novo study time treatment	4 (11.8)

Note: Table values are mean ± SD or n (%). n denotes the number of eyes included.

Abbreviations: AMD indicates age-related macular degeneration; DME, diabetic macular edema; SD, standard deviation; IQR, interquartile range.

Table 2 Demographics and Baseline Characteristics of the Patients and Eyes Included in This Study

Parameter	n = 34 Patients
Baseline age (years)	67.68 ± 21.77
Final age (years)	71.35 ± 21.86
Gender n (%) (male)	18 (52.9)
Follow-up time (years)
Mean ± SD	3.66 ± 1.89
Median (IQR)	3.42 (3.32)
Range	1.11–7.78
	n = 68 eyes
Injected Eyes	34 (50)
Fellow Eyes	34 (50)
Type of Glaucoma
POAG	32 (47.1)
NTG	6 (8.8)
Glaucoma Suspect	18 (26.5)
OHT	12 (17.6)
BCVA (logMAR units)	0.48 ± 0.49 (n=68)
IOP (mmHg)	17.15 ± 4.89 (n=68)
Visual Field MD (dB)	−8.38 ± 6.86 (n=42)
RNFL thickness (μm)	80.43 ± 16.76 (n=68)

Note: Table values are mean ± SD or n (%). n denotes the number of eyes or patients included.

Abbreviations: SD indicates standard deviation; IQR, interquartile range; POAG, primary open-angle glaucoma; NTG, normal-tension glaucoma; OHT, ocular hypertension; BCVA, best-corrected visual acuity; IOP, intraocular pressure; logMAR, logarithmic minimum angle of resolution; MD, mean deviation; RNFL, retinal nerve fiber layer.

Table 3 Evolution of Glaucoma Features and Treatment in the Paired Injected Eyes (n = 34 Eyes) and Fellow Uninjected Eyes (n = 34 Eyes) Included. Parameters Were Compared Within Groups and in Both Groups, According to Injection Status

Parameter	Injected Eyes (n=34)			Uninjectes Eyes (n=34)			p*
	Baseline	Final	p	Baseline	Final	p
RNFL thickness (μm)	80.92 ± 15.78 (n=34)	77.20 ± 17.35 (n=34)	<0.001	79.95 ± 17.91 (n=34)	76.61 ± 17.97 (n=34)	<0.001	0.716
IOP (mmHg)	16.62 ± 4.77 (n=34)	15.09 ± 4.34 (n=34)	0.119	17.68 ± 5.01 (n=34)	14.50 ± 3.39 (n=34)	0.005	0.248
BCVA (logMAR units)	0.64 ± 0.48 (n=34)	0.71 ± 0.57 (n=34)	0.517	0.31 ± 0.44 (n=34)	0.39 ± 0.47 (n=34)	0.082	0.911
Visual Fields MD (dB)	−10.50 ± 7.76 (n=20)	−11.74 ± 8.42 (n=20)	0.209	−6.72 ± 5.60 (n=20)	−7.38 ± 5.84 (n=20)	0.285	0.605
Visual Fields PSD (dB)	6.95 ± 3.74 (n=20)	7.93 ± 3.76 (n=20)	0.132	5.55 ± 3.69 (n=20)	5.96 ± 3.98 (n=20)	0.268	0.434
Visual Fields Foveal Sensitivity (dB)	27.05 ± 8.79 (n=20)	24.60 ± 9.94 (n=20)	0.246	31.20 ± 7.70 (n=20)	31.60 ± 7.69 (n=20)	0.366	0.188
Central Corneal Thickness (μm)	538.56 ± 40.88 (n=16)			538.50 ± 38.04 (n=16)			0.996
Lens Status			0.063			0.031	0.742
Phakic	20 (58.8)	15 (44.1)		23 (67.6)	17 (50)
Pseudophakic	14 (41.2)	19 (55.9)		11 (32.4)	17 (50)
Aphakic	0 (0)	0 (0)		0 (0)	0 (0)
Glaucoma Medical Treatment	19 (55.9)	26 (76.5)	0.039	20 (58.8)	26 (76.5)	0.031	1.000
Number of Glaucoma Medications	1.03 ± 1.11	1.59 ± 1.18	0.003	1.09 ± 1.11	1.56 ± 1.19	0.003	0.833
Glaucoma Laser Treatment	1 (2.9)	4 (11.8)	0.250	1 (2.9)	4 (11.8)	0.250	1.000
SLT	0 (0)	3 (8.8)	0.250	0 (0)	3 (8.8)	0.250
Laser Iridotomy	1 (2.9)	2 (5.9)	1.000	1 (2.9)	1 (2.9)	1.000
Surgical Treatment	3 (8.8)	3 (8.8)	1.000	3 (8.8)	3 (6.8)	1.000	1.000
Trabeculectomy	3 (8.8)	3 (8.8)	1.000	3 (8.8)	3 (8.8)	1.000
Tube Shunt	0 (0)	0 (0)		0 (0)	0 (0)

Notes: *The first two p values represent the comparison between baseline and final values for each parameter in each group (injected eyes only or uninjected eyes only). The final p value, in the last column, represents the comparison of the variation of each parameter between groups (injected eyes vs fellow uninjected eyes). Bold values correspond to p values <0.05 - statistically significant

Abbreviations: RNFL indicates retinal nerve fiber layer; IOP, intraocular pressure; BCVA, best-corrected visual acuity; dB, decibel; logMAR, logarithmic minimum angle of resolution; MD, mean deviation; PSD, pattern standard deviation; SLT, selective laser trabeculoplasty. Table values are mean ± SD or n (%).

Figure 2 Baseline and final RNFL thickness registered throughout follow-up in all study eyes.