Change of Retinal Nerve Fiber Layer Thickness in Various Retinal Diseases Treated With Multiple Intravitreal Antivascular Endothelial Growth Factor

Abstract

Multiple intravitreal injections of anti-VEGF did not lead to significant change in RNFL thickness in wet AMD, DMR, and RVO patients. Furthermore, IOP fluctuations and number of injections did not appear to adversely affect RNFL thickness. Decreased RNFL thickness associated with severity of retinal ischemia in the DMR and RVO patients suggests that inner retinal ischemia itself could be a cause of RNFL loss rather than anti-VEGF effect.

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

“…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.…”

“…The general consensus is that a spike in IOP after intravitreal injection of anti-VEGF agents is common and is caused by the increased volume. In most cases, the spike is transient, and routine prophylactic use of IOP-lowering medications is not necessary525. Moreover, our study showed that repeated IOP fluctuations would not cause RNFL damage; however, our study did not include any patients with glaucoma.…”

“…Earlier studies have reported that inner retinal ischemia can cause ganglion cell death and axonal degeneration, resulting in an RNFL defect202122. The RNFL loss in DME patients may be more closely related to vascular abnormalities and retinal ischemia5 than the anti-VEGF and anti-PIGF effects.…”

“…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.…”

Macular Ganglion Cell Complex and Retinal Nerve Fiber Layer Comparison in Different Stages of Age-Related Macular Degeneration

“…16,17,26,27 We acknowledge that our study has a number of shortcomings, including the relatively limited number of patients, and the absence of a longitudinal follow-up to assess possible changes in GCC and RNFL thickness.…”