Eyeworld

MARCH 2020 | EYEWORLD | 81 C who received injections in one eye only, the researchers compared corneal nerve density in the injected case eye to the non-injected control eye. They also compared corneal nerve density in individuals who received injections in one or both eyes to those who had no history of anti-VEGF injections. With both comparisons, investigators found the same thing. "It didn't matter if it was one injection or 100 injections, eyes that were injected with an anti-VEGF agent had lower nerve densities than eyes that had not," Dr. Galor said. Raquel Goldhardt, MD, pointed out that almost all the nerve parameters were decreased. "It was not just corneal nerve density," Dr. Goldhardt said, adding that investigators looked at branching, length, and number of nerves. Dr. Galor noted that the measurement software employed quantified nine dif- ferent facets of the nerves and found that most of them were decreased. "Those that received the anti-VEGF had very different nerve parameters," Dr. Galor said. Investigators interpreted this as show- ing that VEGF in humans probably has a role in keeping corneal nerves healthy, Dr. Galor said. However, she added that blocking VEGF is needed in several retinal diseases. Still, there were limitations in considering the clinical effects. "We didn't measure things like corneal sensation, and we didn't see any clinical issues like epithelial defects or scarring associated with the change in nerve density," Dr. Galor said. "We're not saying that our find- ings are clinically significant." Rather, she views this as indicating that more study is needed. Drs. Galor and Goldhardt hope that prac- titioners come away from the study with the understanding that VEGF has an effect on cor- neal nerves. "We saw a change in the anatomy and the morphology of the nerves," they said, adding that while they didn't see a clinical effect, if one is identified, there are a lot of patients P atients who receive anti-VEGF injections have a lower corneal nerve density compared to those who have not received these injections, study results indicate. 1 The impetus for the study came from some earlier work conducted by Mark Rosenblatt, MD, who had researched VEGF A and VEGF B on animal corneas, said Anat Galor, MD. "He was the one who gave us the idea when he talked about VEGF as a neu- rotrophic agent along with being an angiogenic agent," Dr. Galor said, explaining that investiga- tors in this recent research wanted to make sure that there was not an adverse effect on corneal nerves that was being missed. Investigators looked at three groups of pa- tients: those who received anti-VEGF injections in one eye only, those who received anti-VEGF injections in both eyes, and controls with no history of anti-VEGF injections. In individuals Examining effect of anti-VEGF on corneal nerves Intravitreal injection Source: Steve Charles, MD Contact Galor: AGalor@med.miami.edu Goldhardt: RGoldhardt@med.miami.edu by Maxine Lipner Senior Contributing Writer About the doctors Anat Galor, MD Associate professor of ophthalmology Bascom Palmer Eye Institute Miami, Florida Raquel Goldhardt, MD Associate professor of clinical ophthalmology Bascom Palmer Eye Institute Miami, Florida Reference 1. Goldhardt R, et al. Effect of anti-vascular endothelial growth factor therapy on corneal nerves. Cornea. 2019;38:559–564. Relevant disclosures Galor: None Goldhardt: None continued on page 82

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