title: Assessment of optic nerve cup-to-disk ratio changes in patients receiving multiple intravitreal injections of antivascular endothelial growth factor agents.
abstract: OBJECTIVE
  To assess whether the transient intraocular pressure rise, frequent intraocular pressure fluctuations, or antivascular endothelial growth factor (VEGF) effects of repeated intravitreal injection of anti-VEGF agents can lead to changes in the optic nerve vertical cup-to-disk ratio (C/D).
  
  
  METHODS
  Patients with a known history of glaucoma and those receiving triamcinolone acetonide were excluded from the study. Fundus photographs were cropped to optic disk images only, which were then randomized and independently graded by two glaucoma specialists. In patients who received treatments in only one eye, the fellow eye was used as a control.
  
  
  RESULTS
  Twenty-three eyes of 21 patients met inclusion criteria. The mean change in C/D was -0.012 (95% confidence interval [CI], -0.053 to 0.029) for the treated group and -0.006 (95% CI, -0.106 to 0.095) for the control group, with no statistically significant difference (P = 0.90). The mean change in C/D for eyes receiving < or =5 injections (n = 9) was 0.003 (95% CI, -0.089 to 0.095) in the treated group and 0.054 (95% CI, -0.033 to 0.142) in the control group, with no statistically significant difference (P = 0.33). In eyes receiving >5 injections (n = 14), the mean change in C/D was -0.021 (95% CI, -0.095 to 0.052) in the treated group and -0.057 (95% CI, -0.231 to 0.116) in the control group, with no statistically significant difference (P = 0.70).
  
  
  CONCLUSIONS
  There was no statistically significant change in the vertical C/D of optic nerves in patients receiving multiple intravitreal injections of anti-VEGF agents, regardless of whether they received fewer or more than five total injections. This suggests that the short-term intraocular pressure rise and frequent intraocular pressure fluctuation, as well as the anti-VEGF properties of these drugs, do not adversely change the optic nerve C/D. Additional prospective studies are warranted to confirm these conclusions.
authors: Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
authors: Rajeev K
authors: RK
authors: Seth
authors: Sarwat
authors: S
authors: Salim
authors: M Bruce
authors: MB
authors: Shields
authors: Ron A
authors: RA
authors: Adelman
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005123:Eye / Q000098:blood supply; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D007267:Injections / Q000009:adverse effects; D007429:Intraocular Pressure / Q000187:drug effects; D009898:Optic Disk / Q000187:drug effects / Q000473:pathology; D009900:Optic Nerve / Q000187:drug effects* / Q000473:pathology*; D000069579:Ranibizumab; D012039:Regional Blood Flow / Q000187:drug effects; D012189:Retrospective Studies; D016037:Single-Blind Method; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014822:Vitreous Body
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide; D042461:Vascular Endothelial Growth Factor A; C495058:pegaptanib; D000069579:Ranibizumab