Can intravitreal anti-VEGF injections affect corneal nerves?
Reviewed by Bushra Thajudeen

This was a retrospective case-control study looking at the effect of anti-VEGF injections on corneal nerves (CN). Fifty-seven patients with a history of at least three anti-VEGF injections in one or both eyes and available confocal microscopic imaging were included in the study. Eighty healthy controls without a history of injection and available confocal microscopic imaging were included as controls. Patients with other anterior segment pathology or previous anterior segment surgery were excluded. For 39 individuals who received anti-VEGF injections in one eye only, the other eye was used as control. They also compared CN parameters between 50 eyes of 50 individuals with a history of IV anti-VEGF injections and 80 eyes of 80 individuals without a history of injection. In vivo confocal microscopic examination was conducted using the ConfoScan 4. Images were analysed by the Corneal Nerve Analysis tool. In 39 patients (own controls), eyes with a history of IV injection had lower CN length density, total length, nerve fibres, bifurcations and branches (p<0.005) compared to the fellow eyes without injection. Similar findings were seen in the eyes of 50 individuals with a history of injection compared to 80 individuals without injection. There were no differences in nerve parameters between eyes that received bevacizumab only (n=25) versus those that received bevacizumab plus aflibercept (n=12) or aflibercept only (n=2). Dry eye symptoms (assessed via the DE Questionnaire-5) were higher in the injected eye (4.6±4.9) compared to the non-injected eye (2.8±4.3), paired t test p<0.0005. There were no significant correlations between nerve parameters and 1) number of injections (bevacizumab, aflibercept, and total), 2) time from first injection to scan, and 3) time from last injection to scan (data not shown), respectively. The authors conclude that although none of the patients receiving anti-VEGF injections had notable corneal abnormalities; ophthalmologists should be aware of changes to corneal nerves and be alert to potential long-term effects of repeated IV anti-VEGF injections.

Effect of anti-vascular endothelial growth factor therapy on corneal nerves.
Goldhardt R, Batawi HIM, Rosenblatt M, et al.
CORNEA
2019;38(5):559-64.