Journal List > J Korean Ophthalmol Soc > v.58(4) > 1010738

Ryu, Shin, Kang, Seong, and Cho: The Effect of Intravitreal Injection on the Corneal Endothelium

Abstract

Purpose

To evaluate the effect of intravitreal injection on the corneal endothelium according to the injected drug.

Methods

The present study included 118 eyes of 113 patients who received intravitreal injection. Before each injection and 1 month after the injection, specular microscopy was performed to evaluate the corneal endothelial changes and central corneal thickness. We classified the patients according to the injected drug (bevacizumab 21 eyes, ranibizumab 20 eyes, aflibercept 47 eyes, dexamathasone implant 30 eyes), phakic or pseudophakic eyes, single or multiple injections and analyzed them retrospectively.

Results

The mean corneal endothelial cell density was 2,693.2 ± 298.2 cells/mm2 before injection and 2,686.8 ± 288.7 cells/mm2 1 month after injection, and there was no statistically significant difference (p = 0.731). According to the kind of drug, the mean corneal endothelial cell density and central corneal thickness were not significantly different before and 1 month after injection in any of the 4 groups.

Conclusions

There were no significant changes in corneal endothelium before and 1 month after intravitreal injection of the vari-ous drugs.

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Table 1.
Descriptive statistics for demographics and clinical characteristics of the study participants
Bevacizumab Ranibizumab Aflibercept Dexamethasone implant
Number of eyes (eyes, %) 21 (17.8) 20 (16.9) 47 (39.8) 30 (25.4)
Mean age (years) 53 69 72 60
Pseudophakic eyes (eyes, %) 4 (19.0) 6 (30.0) 16 (34.0) 14 (46.7)
Diagnosis (eyes)
ARMD 3 16 41 1
DME 14 1 6 19
RVO with ME 4 2 0 10
Uveitis 0 1 0 0

Values are presented as n (%) unless otherwise indicated.

ARMD = age-related macular degeneration; DME = diabetic macular edema; RVO with ME = retinal vein occlusion with macular edema.

Table 2.
Comparision of corneal endothelial change after intravitreal injection according to the type of drugs
Cell density (cells/mm2) Endothelial cell loss (%)* CV Hexagonality (%) CCT (μ m)
Bevacizumab
Initial 2,809.5 ± 206.4 0.26 33.6 ± 6.5 44.1 ± 6.4 545.4 ± 39.2
After 1 month 2,744.0 ± 101.1 30.0 ± 3.2 50.0 ± 12.0 546.9 ± 38.2
p-value 0.345 0.715 0.416 0.825
Ranibizumab
Initial 2,580.8 ± 388.9 0.26 37.3 ± 5.3 47.3 ± 8.1 546.0 ± 62.3
After 1 month 2,560.8 ± 286.9 48.8 ± 26.5 43.5 ± 7.7 524.8±82.1
p-value 0.285 0.285 0.285 0.537
Aflibercept
Initial 2,723.3 ± 64.0 0.65 28.3 ± 4.9 51.3 ± 11.7 587.7 ± 20.0
After 1 month 2,657.7 ± 35.2 33.0 ± 2.6 47.3 ± 6.4 570.0 ± 42.0
p-value 0.401 0.051 0.498 0.328
Dexamethasone implant
Initial 2,617.3 ± 359.8 -0.19 40.4 ± 23.8 47.6 ± 8.7 544.2 ± 44.4
After 1 month 2,659.3 ± 351.3 30.5 ± 5.9 54.3 ± 9.8 535.4 ± 39.0
p-value 0.574 0.269 0.202 0.119

Values are presented as mean ± SD unless otherwise indicated.

CV = coefficient of variation of cell area; CCT = central corneal thickness.

* Endothelial cell loss = (cell density before injection-cell density after injection)/cell density before injection;

Wilcoxon-signed rank test;

Paired t-test.

Table 3.
Changes in corneal endothelial cell density after intravitreal injection classified with the phakic or pseudophakic eyes
Total Bevacizumab Ranibizumab Aflibercept Dexamethasone implant
Phakic Pseudophakic Phakic Pseudophakic Phakic Pseudophakic Phakic Pseudophakic Phakic Pseudophakic
Initial 2,611.7 2,778.0 ± 2,800.4 2,759.5 ± 2,696.8 2,409.3 ± 2,787.2 2,588.9 ± 2,561.7 2,672.0 ±
(cells/mm2) ± 470.2 149.3 ± 200.3 219.8 ± 215.9 563.4 ± 219.8 220.3 ± 464.2 234.5
After 1 month (cells/mm2) 2,480.0 ± 436.4 2,608.2 ± 334.8 2,783.5 ± 216.5 2,808.0 ± 418.7 2,670.1 ± 281.4 2,436.7 ± 262.0 2,750.8 ± 252.1 2,579.6 ± 262.1 2,704.8 ± 374.6 2,616.1 ± 276.7
p-values* 0.285 0.345 0.831 0.461 0.221 0.753 0.304 0.877 0.196 0.507
Endothelial 0.37 0.34 0.06 -1.19 1.02 0.01 0.82 -0.16 -0.88 -0.13
cell loss (%)

Values are presented as mean ± SD unless otherwise indicated.

* Wilcoxon-signed rank test;

Endothelial cell loss = (cell density before injection-cell density after injection)/cell density before injection.

Table 4.
Changes in corneal endothelial cell density after intravitreal injection classified with the number of injection
Single injection group Multiple injection group
Initial (cells/mm2) 2,713.0 ± 299.5 2,723.3 ± 64.0
After 1 month (cells/mm2) 2,673.6 ± 314.6 2,793.0 ± 93.0
p-values* 0.525 0.109
Endothelial cell loss (%) 0.19 -0.03

Values are presented as mean ± SD unless otherwise indicated.

* Wilcoxon-signed rank test;

Endothelial cell loss = (cell density before injection-cell density after injection)/cell density before injection).

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