Effect of Repeated Intravitreal anti-Vascular Endothelial Growth Factor Drugs on Corneal Endothelium

Abstract

Abstract Objective To investigate the potential effect of repeated intravitreal injection of anti-Vascular Endothelial Growth factor(anti-VEGF)drugs on corneal endothelium in patients with macular edema. Methods This is a prospective study in which a total of 64 patients (64 eyes) were treated with intravitreal injection of anti-VEGF. There were 19 cases of neovascular Age-Related Macular Degeneration (nAMD), 20 cases of Diabetic Macular Edema (DME)and 25 cases of Retinal Vein Occlusion (RVO). 29 cases were treated with Aflibercept (2mg/0.05ml) and 35 cases with Ranibizumab (0.5mg /0.05ml). 3 + PRN therapy was used. Corneal endothelial microscopy was used to measure the corneal thickness and corneal endothelium. The various changes in corneal thickness, corneal endothelial cell density, average cell area, coefficient of variation, and proportion of hexagonal cells were compared between one month after each injection and before injection. Results The proportion of corneal endothelial hexagonal cells (Hex%) in the operative eyes after the 2nd and 3rd injection was found to be significantly lower than that of baseline. Hex% in the operative eyes after the 4th injection was lower than that of baseline, 2nd as well 3rd injection and the difference was statistically significant (P < 0.05). The number of injections was irrelevant to the changes of corneal endothelium. There were no statistically significant differences in all corneal endothelial indexes in contralateral eye. Conclusion Repeated intravitreal anti-VEGF drugs can affect the morphology of corneal endothelial cells. Thus, for patients with fundus disease who need multiple intravitreal injection of anti-VEGF drugs, attention should be paid to the changes of corneal endothelium, especially for those suffering with diabetes, a history of eye surgery (such as cataract surgery), or patients with high intraocular pressure and other diseases that can adversely affecting corneal endothelium.