engleski

The effect of intravitreal bevacizumab injections on retinal nerve fiber layer thickness in glaucoma patients

Objectives: Intravitreal injections of anti- VEGF agents have been widely used and intensively developed as a treatment option for many ophthalmological indications. The most frequently used anti-VEGF agent in Croatia is bevacizumab. This type of therapy is mostly indicated in patients with exudative age- related macular degeneration and diabetic macular edema. 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 fibre layer (RNFL) thinning. The aim of this prospective study was to establish whether administering bevacizumab to patients with primary open angle glaucoma leads to additional thinning of the RNFL. Subjects and methods: The study included 60 patients divided into two groups. The first group comprised the eyes of 30 patients with exudative ARMD and POAG, whereas the second group comprised the eyes of 30 patients with diabetic macular edema (DME) and POAG, all treated with bevacizumab. The 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 OCT (optical coherence tomography) measurements of ONH retinal nerve fibre layer thickness (RNFL). We compared the results of all patients and subsequently compared them with control group results. Results: The results showed decrease of RNFL in both groups of patients. First group of patients showed no statistically significant difference between treated and untreated eye (p=0, 758). In the second group there was statistically significant difference between treated and untreated eye in RNFL thickness ( p= 0, 023).A comparison of these two groups of patients after one year revealed a statistically more significant RNFL thickness decrease in the second group ( p=0, 023). Conclusion: Multiple intravitreal bevacizumab injections have possible toxic effect on RNFL thickness in group of patients with DME and POAG during follow up period of one year, while in the group of patients with exudative age- related macular degeneration, bevacizumab doesn't have that effect.

bevacizumab, exudative senile macular degeneration, diabetic macular edema, primary open angle glaucoma, retinal nerve fiber layer thickness

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