Corneal Endothelial Cell Changes Associated with Multiple Intravitreal Injections

• Published in: Iranian journal of ophthalmology Vol. 36; no. 3; pp. 279 - 283
• Main Authors: Malvasi, Mariaelena, Mangiantini, Pietro, Testa, Floriana, Battagliola, Edoardo Trovato, D'Andrea, Mattia, Minozzi, Guglielmo, Turchetti, Paolo, Pacella, Elena
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer - Medknow 01.07.2024; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Edition: 2
• Subjects: anti-vascular endothelial growth factor; Cornea; corneal endothelium; dexamethasone implant; endothelial cell count; Endothelium; intravitreal injections; Original; Original Article; Regression analysis; Vascular endothelial growth factor; Endothelial cell count; Anti-vascular endothelial growth factor; Dexamethasone implant; Intravitreal injections; Corneal endothelium
• ISSN: 2452-2325; 2452-2325
• DOI: 10.4103/joco.joco_26_23

Purpose: To explore the changes in the corneal endothelium in patients who receive multiple anti-vascular endothelial growth factor (anti-VEGF) or steroid injections for posterior segment pathology. Methods: This cross-sectional study recruits subjects treated with intravitreal anti-VEGF or sustained-release dexamethasone for macular edema due to retinal vein occlusion. Corneal endothelium and corneal thickness were measured in the treated eye using a corneal endothelial microscope. The study variables include age, endothelial cell density (ECD), coefficient of variation (CV) of cell size, percentage of hexagonality (HEX%), and intraocular pressure (IOP) change 30 min after injection. These variables were analyzed using multiple linear regression analysis. Results: A total of 108 diseased eyes were treated with a variable number (from 4 to 28) of intravitreal injections between January 2020 and December 2023. The mean total number of intravitreal injections was 12.8/eye. Multiple linear regression analysis showed an inverse relationship between ECD and age (β = −9.74, 95% confidence interval [CI] [−8.01, −10.24], P < 0.05) and total number of injections (β = −17.11, 95% CI [−16.44, −18.37], P < 0.05). An inversion relationship also exists between HEX% and age (β = −0.17, 95% CI [−0.11, −0.23], P < 0.05) and total number of injections (β = −0.45, 95% CI [−0.37, −0.54], P < 0.05). A direct relationship exists between CV and age (β =0.29, 95% CI [0.19, 0.40], P < 0.05) and total number of injections (β =0.54, 95% CI [0.45, 0.63], P < 0.05). The mean IOP difference between the injected and contralateral eye 30 min postinjection was +6.4 ± 3 mmHg (P < 0.05). Conclusion: A greater number of intravitreal injections is associated with a lower ECD, lower HEX, and higher CV in the treated eyes.