The Effect of Intravitreal Injection on the Corneal Endothelium

So Jung Ryu; Yong Un Shin; Min Ho Kang; Mincheol Seong; Hee Yoon Cho

doi:10.3341/jkos.2017.58.4.401

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

Original Article

J Korean Ophthalmol Soc 2017;58(4):401-407.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.4.401

The Effect of Intravitreal Injection on the Corneal Endothelium

So Jung Ryu, M.D., Yong Un Shin, MD, PhD, Min Ho Kang, MD, PhD, Mincheol Seong, MD, PhD, Hee Yoon Cho, MD, PhD

Department of Ophthalmology, Guri Hospital, Hanyang University College of Medicine, Guri, Korea

Address reprint requests to Hee Yoon Cho, MD, PhD Department of Ophthalmology, Hanyang University Guri Hospital, #153 Gyeongchun-ro, Guri 11923, Korea Tel: 82-31-560-2354, Fax: 82-31-564-9479 E-mail: hycho@hanyang.ac.kr

Received 8 December 201622 February 2017 Accepted 31 March 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Corneal endothelium, Intravitreal injection, Specular microscopy

References

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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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