Intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents is a commonly used treatment for various ophthalmic conditions. One of these includes age-related macular degeneration. These injections are used to prevent vision loss and this therapy requires patients to receive monthly injections for up to 2 years. It should be taken into consideration that identifying the specific role that intravitreal injections play in the development of dry eye syndrome is difficult, as the patient's age and other age-related diseases may also contribute. Despite this, it is important to be aware that these preexisting conditions make patients more vulnerable to developing dry eyes when having intravitreal injections. It is likely, then, that this treatment is a factor in the development of dry eye syndrome.
The main purpose of this study by Pastor-Pascual et al was to assess the use of artificial tears in patients submitted to intravitreal injections of anti-VEGF agents using both subjective and objective metrics.
Thirty-four eyes undergoing anti-VEGF treatment were analyzed. Each patient underwent a subjective and objective evaluation of the ocular surface, using the Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire (DEQ)-5, tear meniscus height (TMH), first and average non-invasive Keratograph Break-Up Time (NIKBUT), bulbar conjunctival redness, meibography and the Vision Break-Up Time (VBUT). Patients attended 5 visits (days 0, 7, 30, 37, and 60). All patients continued with their intravitreal injection treatment during the study (days 0, 30, and 60). Patients did not receive any artificial tear treatment during the first month of the study, and at the baseline visit they were randomly assigned to one of two study groups to receive either the Systane Hydration or the Viscofresh 10mg/mL formulation. Patients were instructed to instill one drop of the assigned study treatment 3 times a day for 30 days during the second month of the study.
According to the Mixed Models for Repeated Measures analysis, there was not enough statistical evidence for any of the parameters examined to determine significant differences between being treated with artificial tears and not being treated (p > 0.05). There was, however, a tendency toward improved outcomes in some parameters when artificial tears were used. OSDI, DEQ-5, TMH, and meibography were not affected by either the type of artificial tear used or by the time (from day 30 to day 60; p > 0.05), but the NIKBUT and VBUT values increased over time during this period regardless of which treatment the patient was receiving.
"In conclusion, we consider that the use of intravitreal injections might affect the ocular surface, and we suggest that the use of artificial tears could help to keep the tear film stable, and therefore, lead to an improved quality of life for those patients receiving intravitreal injections. Future studies should be conducted with large samples, long follow-up periods, and considering more types of artificial tears available on the market to elucidate whether the tendency reported in our study becomes significant."
Source: Pastor-Pascual et al; Clinical Ophthalmology 2022:16
https://doi.org/10.2147/OPTH.S391082