Dry Eye and Meibomian Gland Dysfunction in Neovascular Age-Related Macular Degeneration Patients Treated with Intravitreal Injections

Abstract

Objectives: To determine if patients treated with multiple intravitreal injections for neovascular age-related macular degeneration are more likely to suffer from dry eye and meibomian gland dysfunction. Materials and Methods: Sixty eyes of 30 patients were enrolled. One eye of each patient was treated with multiple monthly intravitreal injections for neovascular AMD (Group 1) and the fellow healthy eye received no treatment (Group 2). The presence of dry eye was evaluated using tear film break-up time, Schirmer 1 test, the Oxford scale, and Ocular Surface Disease Index (OSDI). The loss rate of meibomian glands was evaluated by meibography and was graded and scored (meiboscore) from grade 0 (no loss of glands) to grade 3 (loss of >2/3 of total meibomian glands) for each eyelid. Results: Group 1 had lower mean Schirmer 1 and tear film break up-time measurements and higher mean OSDI score than Group 2, but the differences were not statistically significant (p=0.257, p=0.113, and p=0.212, respectively). Mean Oxford scale scores and meiboscore of the upper eyelids showed no statistically significant difference between the groups (p=0.594, p=0.663, respectively). The meiboscore of the lower eyelids was significantly higher in Group 1 (p=0.048). Conclusion: Multiple factors such as povidone-iodine and the preservatives in topical eye drops may cause inflammation leading to ocular surface damage in patients treated with multiple intravitreal injections. As the treatment requires repeated injections, exposure to these factors might worsen the ocular surface inflammation. The possibility of dry eye and meibomian gland dysfunction should be considered in these patients.

The Inflammatory and Cytological Effect of Repeated Povidone-Iodine Application in Patients Receiving Intravitreal Injections

“…However, there are limited clinical studies on this procedure, which has been widely used in ophthalmology practice. [9][10][11]19,20 In this study, the injection eyes and fellow eyes of patients with AMD with unilateral injection were compared. Thus, the effect of confounding factors that could affect the results, such as systemic disease, age, and sex, was minimized.…”

“…However, there are limited clinical studies on this procedure, which has been widely used in ophthalmology practice. 9–11,19,20…”

The Use of Venous Catheter and Irrigation with Povidone-Iodine 0.6% in Patients with Punctal and Proximal Canalicular Stenosis: Preliminary Report

“…Recent studies have demonstrated the efficacy of 0.6% povidone-iodine (PVI) in treating ocular surface diseases, improving signs and symptoms in patients with dry eye disease (DED) and Meibomian gland dysfunction (MGD) [ 17 ]. PVI is an antiseptic with several properties, such as immediate broad-spectrum activity against different types of bacteria, with no reported microbial resistance.…”

“…Moreover, PVI presents effective anti-inflammatory activity as well as great efficacy in wound healing. It has been shown to be safe and very well tolerated [ 17 ]. Although PVI is generally safe, some complications have been described in the literature, such as allergic reactions, ocular irritation, post-operative eye pain, and corneal toxicity [ 18 , 19 ].…”