title: Change of retinal nerve fiber layer thickness in various retinal diseases treated with multiple intravitreal antivascular endothelial growth factor.
abstract: OBJECTIVE
  To investigate the effect of multiple intravitreal injection of anti-VEGF on the retinal nerve fiber layer (RNFL) in AMD, diabetes mellitus retinopathy (DMR), and retinal vein occlusion (RVO).
  
  
  METHODS
  In this retrospective controlled case series, we reviewed the AMD, DMR, and RVO patients who received more than three anti-VEGF injections (injection group: 148 eyes). Patients without treatment were included as a control group (noninjection group: 183 eyes). RNFL thickness was measured by SD-OCT. Also, correlation between RNFL change and associated factors, including intraocular pressure (IOP), injection times, and severity of retinal ischemia, were analyzed using multivariate logistic regression.
  
  
  RESULTS
  RNFL thickness (μm) had not changed in AMD, but it decreased from 100.0 to 97.1, and from 101.1 to 98.0 in injection groups of DMR and RVO, respectively, as well as the noninjection group. However, decreased RNFL thickness of the injection groups was not significantly different from those of the noninjection groups. Severity of retinal ischemia was associated with decreased RNFL thickness (odds ratio: 4.667). However, number of injections and IOP-related variables had no association with RNFL change.
  
  
  CONCLUSIONS
  Multiple intravitreal injections of anti-VEGF did not lead to significant change in RNFL thickness in wet AMD, DMR, and RVO patients. Furthermore, IOP fluctuations and number of injections did not appear to adversely affect RNFL thickness. Decreased RNFL thickness associated with severity of retinal ischemia in the DMR and RVO patients suggests that inner retinal ischemia itself could be a cause of RNFL loss rather than anti-VEGF effect.
authors.affiliation: Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Shin
authors.forename: Ki Cheul
authors.initials: KC
authors.lastname: Shin
authors.forename: Hyewon
authors.initials: H
authors.lastname: Chung
authors.forename: Hyung Chan
authors.initials: HC
authors.lastname: Kim
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000068258:Bevacizumab; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000378:metabolism / Q000473:pathology*; D012164:Retinal Diseases / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D012165:Retinal Ganglion Cells / Q000378:metabolism / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab
keywords: age-related macular degeneration; antivascular endothelial growth factor; diabetes mellitus retinopathy; retinal ischemia; retinal nerve fiber layer thickness; retinal vein occlusion