Impact of repeated anti-VEGF injections on the corneal nerve plexus in patients with Wet-AMD

PURPOSE: The study aims to evaluate the effects of anti-vascular endothelial growth factor (anti-VEGF) treatment on corneal nerve morphology and ocular surface health in patients with unilateral wet age-related macular degeneration (AMD).
METHODS: The study included 48 patients who received at least three unilateral intravitreal anti-VEGF injections for wet AMD and 25 subjects who were healthy. Corneal nerve morphology was assessed using in vivo confocal microscopy, and ocular surface health by tear film parameters and ocular surface disease index scores. The effects of different anti-VEGF agents (bevacizumab, ranibizumab, and aflibercept) were also compared.
RESULTS: The results showed a marked decline in corneal nerve fiber width (CNFW) in anti-VEGF-treated eyes compared to untreated eyes and healthy control eyes. However, no notable discrepancies in other corneal nerve parameters, tear film parameters, and corneal sensitivity were found between treated, untreated eyes, and healthy control eyes. Furthermore, no statistically significant change was noted between the effects of different anti-VEGF agents on corneal nerves.
CONCLUSION: Anti-VEGF treatment may affect corneal nerve structure, as indicated by a decrease in CNFW, but does not necessarily lead to changes in corneal sensitivity and tear film parameters. The results of the study suggest that anti-VEGF treatment appears to be safe in terms of its effects on corneal nerves, but further research, especially longitudinal studies, are required to validate these findings.

Keywords: Age-related macular degeneration, anti-vascular endothelial growth factor, subbasal corneal nerve fiber plexus.