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.

1.
Solomon SD, Lindsley K, Vedula SS, Krzystolik MG, Hawkins BS: Anti-vascular endothelial growth factor for neovascular age-related macular degeneration. Cochrane Database Syst Rev 2014;8:CD005139.
2.
Muether PS, Hermann MM, Koch K, Fauser S: Delay between medical indication to anti-VEGF treatment in age-related macular degeneration can result in a loss of visual acuity. Graefes Arch Clin Exp Ophthalmol 2011;249:633-637.
3.
Muether PS, Hoerster R, Hermann MM, Kirchhof B, Fauser S: Long-term effects of ranibizumab treatment delay in neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2013;251:453-458.
4.
Kiss S, Liu Y, Brown J, Holekamp NM, Almony A, Campbell J, Kowalski JW: Clinical monitoring of patients with age-related macular degeneration treated with intravitreal bevacizumab or ranibizumab. Ophthalmic Surg Lasers Imaging Retina 2014;45:285-291.
5.
Ziemssen F, Eter N, Fauser S, Bopp S, Radermacher M, Hasanbasic Z, Holz FG; AURA-Studiengruppe: Retrospective investigation of anti-VEGF treatment reality and effectiveness in patients with neovascular age-related macular degeneration (AMD) in Germany: treatment reality of ranibizumab for neovascular AMD in Germany (in German). Ophthalmologe 2015;112:246-254.
6.
Agard E, Elchehab H, Ract-Madoux G, Russo A, Lagenaite C, Dot C: Repeated intravitreal anti-vascular endothelial growth factor injections can induce iatrogenic ocular hypertension, especially in patients with open-angle glaucoma. Can J Ophthalmol 2015;50:127-131.
7.
Bressler SB, Almukhtar T, Bhorade A, Bressler NM, Glassman AR, Huang SS, Jampol LM, Kim JE, Melia M: Repeated intravitreous ranibizumab injections for diabetic macular edema and the risk of sustained elevation of intraocular pressure or the need for ocular hypotensive treatment. JAMA Ophthalmol 2015;133:589-597.
8.
Morshedi RG, Ricca AM, Wirostko BM: Ocular hypertension following intravitreal antivascular endothelial growth factor therapy: review of the literature and possible role of nitric oxide. J Glaucoma 2016;25:291-300.
9.
Demirel S, Yanik O, Batioglu F, Ozmert E: Intraocular pressure changes related to intravitreal injections of ranibizumab: analysis of pseudophakia and glaucoma subgroup. Int Ophthalmol 2015;35:541-547.
10.
Kim YJ, Sung KR, Lee KS, Joe SG, Lee JY, Kim JG, Yoon YH: Long-term effects of multiple intravitreal antivascular endothelial growth factor injections on intraocular pressure. Am J Ophthalmol 2014;157:1266-1271.e1.
11.
Aref AA: Management of immediate and sustained intraocular pressure rise associated with intravitreal antivascular endothelial growth factor injection therapy. Curr Opin Ophthalmol 2012;23:105-110.
12.
Goktas A, Goktas S, Atas M, Demircan S, Yurtsever Y: Short-term impact of intravitreal ranibizumab injection on axial ocular dimension and intraocular pressure. Cutan Ocul Toxicol 2013;32:23-26.
13.
Horsley MB, Mandava N, Maycotte MA, Kahook MY: Retinal nerve fiber layer thickness in patients receiving chronic anti-vascular endothelial growth factor therapy. Am J Ophthalmol 2010;150:558-561.e1.
14.
Martinez-de-la-Casa JM, Ruiz-Calvo A, Saenz-Frances F, Reche-Frutos J, Calvo-Gonzalez C, Donate-Lopez J, Garcia-Feijoo J: Retinal nerve fiber layer thickness changes in patients with age-related macular degeneration treated with intravitreal ranibizumab. Invest Ophthalmol Vis Sci 2012;53:6214-6218.
15.
Demirel S, Batioglu F, Ozmert E, Erenler F: The effect of multiple injections of ranibizumab on retinal nerve fiber layer thickness in patients with age-related macular degeneration. Curr Eye Res 2015;40:87-92.
16.
Shin HJ, Kim SN, Chung H, Kim TE, Kim HC: Intravitreal anti-vascular endothelial growth factor therapy and retinal nerve fiber layer loss in eyes with age-related macular degeneration: a meta-analysis. Invest Ophthalmol Vis Sci 2016;57:1798-1806.
17.
Parlak M, Oner FH, Saatci AO: The long-term effect of intravitreal ranibizumab on retinal nerve fiber layer thickness in exudative age-related macular degeneration. Int Ophthalmol 2015;35:473-480.
18.
Beck M, Munk MR, Ebneter A, Wolf S, Zinkernagel MS: Retinal ganglion cell layer change in patients treated with anti-vascular endothelial growth factor for neovascular age-related macular degeneration. Am J Ophthalmol 2016;167:10-17.
19.
Muether PS, Hermann MM, Droge K, Kirchhof B, Fauser S: Long-term stability of vascular endothelial growth factor suppression time under ranibizumab treatment in age-related macular degeneration. Am J Ophthalmol 2013;156:989-993.e2.
20.
Fauser S, Muether PS: Clinical correlation to differences in ranibizumab and aflibercept vascular endothelial growth factor suppression times. Br J Ophthalmol 2016, DOI: 10.1136/bjophthalmol-2015-308264.
21.
Enders P, Muether PS, Hermann M, Ristau T, Fauser S: Long-term alterations of systemic vascular endothelial growth factor levels in patients treated with ranibizumab for age-related macular degeneration. Retina 2015;35:454-458.
22.
Chauhan BC, Danthurebandara VM, Sharpe GP, Demirel S, Girkin CA, Mardin CY, Scheuerle AF, Burgoyne CF: Bruch's membrane opening minimum rim width and retinal nerve fiber layer thickness in a normal white population: a multicenter study. Ophthalmology 2015;122:1786-1794.
23.
Enders P, Schaub F, Hermann MM, Cursiefen C, Heindl LM: Neuroretinal rim in non-glaucomatous large optic nerve heads: a comparison of confocal scanning laser tomography and spectral domain optical coherence tomography. Br J Ophthalmol 2016;101:138-142.
24.
Vianna JR, Danthurebandara VM, Sharpe GP, Hutchison DM, Belliveau AC, Shuba LM, Nicolela MT, Chauhan BC: Importance of normal aging in estimating the rate of glaucomatous neuroretinal rim and retinal nerve fiber layer loss. Ophthalmology 2015;122:2392-2398.
25.
El-Ashry MF, Lascaratos G, Dhillon B: Evaluation of the effect of intravitreal ranibizumab injections in patients with neovascular age related macular degeneration on retinal nerve fiber layer thickness using optical coherence tomography. Clin Ophthalmol 2015;9:1269-1274.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.