Retinal Nerve Fiber Loss in Anti-VEGF Therapy for Age-Related Macular Degeneration Can Be Decreased by Anterior Chamber Paracentesis

Abstract

Purpose: To analyze peripapillary retinal nerve fiber layer thickness (RNFLT) change after long-term intravitreal anti-VEGF therapy. Patients with regular anterior chamber paracentesis (ACP) prior to intravitreal injections (IVIs) were compared to those without ACP. Methods: Neovascular age-related macular degeneration (nAMD) was treated in a pro re nata regimen with a minimum of 9 IVIs. RNFLT change was determined in spectral domain optical coherence tomography. Results: In 32 patients without ACP, mean RNFLT loss (-2.16 ± 3.60 µm) was significantly higher than in 44 patients with regular ACP (0.16 ± 3.60; p = 0.029). Both groups were comparable in age (75.0 vs. 76.8 years; p = 0.35), number of IVIs (16.2 vs. 16.6; p = 0.98), and observational time (30.0 vs. 32.3 months; p = 0.32). In patients without ACP, RNFLT loss was higher compared to IVI-naive fellow eyes (p = 0.005), whereas in ACP patients, no difference was detected (p = 0.5). Conclusions: A moderate RNFLT loss is found in nonglaucomatous patients after injection therapy for nAMD. As it is decreased with regular ACP, tight management of intraocular pressure seems advisable.

Microvascular abnormalities and long-term efficacy after stereotactic radiotherapy under continued intravitreal anti-VEGF treatment for neovascular AMD

“…It has recently been shown that intravitreal injection monotherapy did not affect peripapillary retinal NFL at least during the first year of treatment, 32 while others did not exclude an effect over 2.5 years. 33 However, together with the finding of parafoveal nasal MVAs, the issue of possible nerve fibre loss in the papillomacular bundle should be followed further.…”

The effects of intravitreal injections on intraocular pressure and retinal nerve fiber layer: a systematic review and meta-analysis

“…Additionally, several studies have shown that prophylactic anterior chamber paracentesis is a safe and effective option for preventing IOP spikes after an intravitreal injection 87,113,114 . Most notably, Enders et al found a significant RNFL-loss in patients who had not undergone anterior chamber paracentesis prior to their intravitreal injections, but could not find a significant reduction in RNFL-thickness in those who did 115 . We can therefore conclude that there are several effective options for IOP prophylaxis.…”

Sicherheit, Effektivität und protektive Wirkung einer Parazentese bei intravitrealen Injektionen: „Eine Lanze für die Parazentese brechen“

“…Im Februar 2017 publizierten Enders et al bei intravitrealen Injektionen mit gleichzeitiger Vorderkammerpunktion vergleichbare Langzeitergebnisse [41]. Sie hatten bei 76 AMD-Patienten ohne Glaukom, die an einem Auge wenigstens 9 intravitreale Injektionen erhalten hatten, die RNFL über 30 Monate bei 44 Augen verfolgt.…”