Retinal Nerve Fiber Layer Thickness in Glaucoma Patients Treated with Multiple Intravitreal Anti-Vegf (Bevacizumab) Injections

Abstract

Over the past decade, intravitreal injections of anti-VEGF agents have been widely used and intensively developed as a treatment option for many ophthalmological indications. Due to its availability and low cost, the most frequently used anti-VEGF agent is bevacizumab. This type of therapy is often indicated in patients with exudative age-related macular degeneration (ARMD) and diabetic macular edema (DME). If, in addition to these two conditions, patients have a diagnosis of primary open angle glaucoma (POAG), they also present with optic nerve head (ONH) retinal nerve fiber layer (RNFL) thinning. The aim of this prospective study was to establish whether administering bevacizumab to patients with POAG leads to additional reduction of RNFL thickness. The study included 60 patients divided into two groups. First group comprised the eyes of patients with exudative ARMD and POAG, whereas second group comprised the eyes of patients with DME and POAG, all treated with bevacizumab. Control group comprised the fellow eye of each involved patient, which was not treated with bevacizumab. In a period of one year, all patients underwent optical coherence tomography (OCT) measurements of ONH RNFL thickness. The results of all patients were compared between the two study groups and then with control group results. Study results showed a decrease of RNFL in both groups of patients. Comparison of these two groups of patients after one year revealed a statistically more significant decrease in RNFL thickness in the second group (DME + POAG).

Keywords

• Vascular endothelial growth factor A
• Bevacizumab
• Retinal degeneration
• Macular edema
• Diabetes mellitus
• Glaucoma, primary open angle