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Effect of Repeated Intravitreal Injections in Glaucoma Spectrum Diseases [Letter]
Authors Budu , Esa T, Idrus HH
Received 23 November 2023
Accepted for publication 29 November 2023
Published 4 December 2023 Volume 2023:17 Pages 3703—3704
DOI https://doi.org/10.2147/OPTH.S451470
Checked for plagiarism Yes
Editor who approved publication: Dr Scott Fraser
Budu,1,* Tenri Esa,2,* Hasta Handayani Idrus3,*
1Department of Ophthalmology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia; 2Department of Clinical Pathology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; 3Center for Biomedical Research, Research Organization for Health, National Research and Innovation Agency (BRIN), Cibinong Science Center, Bogor, West Java, Indonesia
*These authors contributed equally to this work
Correspondence: Budu, Department of Ophthalmology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia, Email [email protected]
View the original paper by Dr Vilares-Morgado and colleagues
A Response to Letter has been published for this article.
Dear editor
We have read the paper written by Vilares-Morgado et al on the Effect of Repeated Intravitreal Injections in Glaucoma Spectrum Diseases.1 We congratulate all authors who have provided important information that helps readers understand the relationship between repeated intravitreal injections (IVI) with anti-vascular endothelial growth factor (anti-VEGF) and the development of glaucoma in eyes with glaucoma spectrum diseases (GSD). The research is quite important considering the number of eye diseases treated with intravitreal injections is increasing and injection of fluids into the eye can cause an increase in intraocular pressure (IOP), which is a major risk factor for glaucoma.2
The study conducted by Vilares-Morgado et al used a retrospective, single-center, and longitudinal study by performing procedures for intravitreal injections, coding was carried out by trained medical coders based on information reported in medical records.1 The methods used were in accordance with goal to be achieved, but we would like to recommend prior patient identification and confirmed or suspected glaucoma in both eyes receiving unilateral intravitreal injections. The primary outcome measure was the difference in the degree of retinal nerve fiber layer (RNFL) thinning in injected eyes versus non-injected eyes. The effects of post-injection increase in Intra Ocular Pressure (IOP), injection frequency, and number of injections were also evaluated.3
In this study, Vilares-Morgado et al found that the proportion of eyes receiving glaucoma treatment increased significantly in eyes that were injected compared to eyes that were not injected.1 Therefore it is necessary to be careful when using this intravitreal drug, although there is still little evidence available regarding long-term effects on RNFL thickness. Some reduction in RNFL thickness appears to occur after intravitreal anti-VEGF injection, but the clinical relevance of this finding remains unclear. The effect of intravitreal injection on glaucoma is not clinically significant, but caution should be exercised when treating patients with advanced glaucoma.2
In conclusion we agree that increased treatment of glaucoma eyes may represent significant RNFL thinning over time. Therefore it must be monitored regularly and closely as well as regular evaluation of the optic nerve to allow early detection of glaucoma development.1 Another thing that needs to be considered is the time point of intravitreal injection around eye trauma, as this can cause various retinal pathologies, in addition to it should be considered carefully when testing treatments in ocular trauma models and in treating ocular trauma patients.4
Disclosure
The authors report no conflicts of interest in this communication.
References
1. Vilares-morgado R, Correia V, Ferreira AM, et al. Effect of repeated intravitreal injections in glaucoma spectrum diseases. Clin Ophthalmol. 2023;17:3613–3627. doi:10.2147/OPTH.S441500
2. de Vries VA, Bassil FL, Ramdas WD. The effects of intravitreal injections on intraocular pressure and retinal nerve fiber layer: a systematic review and meta-analysis. Sci Rep. 2020;10(1):1–10. doi:10.1038/s41598-020-70269-7
3. Swaminathan SS, Kunkler AL, Quan AV, et al. Rates of RNFL thinning in patients with suspected or confirmed glaucoma receiving unilateral intravitreal injections for exudative AMD. Physiol Behav. 2021;176(3):139–148. doi:10.1016/j.ajo.2020.12.016.Rates
4. Thomas CN, Bernardo-Colón A, Courtie E, et al. Effects of intravitreal injection of siRNA against caspase-2 on retinal and optic nerve degeneration in air blast induced ocular trauma. Sci Rep. 2021;11(1):1–15. doi:10.1038/s41598-021-96107-y
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