Clinical Report: Dry Eye Management in Patients Undergoing Anti-VEGF Injections

Overview

Repeated intravitreal anti-VEGF injections can significantly reduce corneal nerve health and increase the risk of neurotrophic keratitis (NK) in patients with AMD and DME. Effective management strategies, including the use of preservative-free artificial tears and Omega-3 supplementation, are crucial for preserving ocular surface integrity.

Background

The use of anti-VEGF injections has become a standard treatment for age-related macular degeneration (AMD) and diabetic macular edema (DME). However, these injections can lead to adverse corneal changes, including reduced nerve density and sensitivity, which may predispose patients to complications such as neurotrophic keratitis. Understanding these effects is essential for optimizing patient care and preventing long-term ocular surface issues.

Data Highlights

Key Findings

• Corneal nerve fiber density and branch density significantly decrease after the third anti-VEGF injection.
• Corneal sensitivity is significantly reduced, leading to increased Ocular Surface Disease Index scores.
• Patients with diabetes may experience exacerbated neuropathy and impaired wound healing due to anti-VEGF injections.
• Osmoprotective preservative-free artificial tears are recommended post-injection to protect the ocular surface.
• Oral Omega-3 supplementation can improve corneal nerve density and tear function in diabetic patients.
• Curcumin may enhance corneal wound healing, although clinical evidence in humans is limited.

Clinical Implications

Clinicians should monitor patients receiving repeated anti-VEGF injections for signs of neurotrophic keratitis and consider implementing protective measures such as preservative-free artificial tears and Omega-3 supplementation. Regular corneal sensation testing is advisable to assess nerve health and guide management strategies.

Conclusion

The management of dry eye in patients undergoing anti-VEGF therapy is critical to maintaining ocular health. By adopting comprehensive care strategies, healthcare professionals can mitigate the risks associated with corneal nerve damage and improve patient outcomes.

References

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