Impact of antiangiogenic therapy on the hemodynamics of the optic nerve and macula in patients with diabetic macular edema and glaucoma

Backgraund: In recent years, the algorithms and standards for the treatment of patients with diabetic macular edema (DME) have changed dramatically due to the widespread use of antiangiogenic therapy and its high clinical efficacy. The safety of intravitreal administration of angiogenesis inhibitors and the risk of possible damaging effects of increased intraocular pressure (IOP) is a subject of discussion and is of great interest. The introduction of the OCT-angiography method provided a unique opportunity not only to study the hemodynamics of the optic nerve disc and the retina, but also to monitor the course of the disease. Aims: To study the changes in the optic disc and retina hemodynamics in the macular region in patients with DMO and glaucoma after anti-VEGF injection. Materials and methods: A prospective observational study was conducted at the ophthalmological department of the Novosibirsk State Regional Hospital. The study included 86 patients (172 eyes). Patient groups were formed according to the presence of clinically significant DME and primary open-angle glaucoma (POAG), both in combination and separately. 1st group - 40 patients (40 eyes) with I stage POAG and DME; Group 2 - 46 patients (46 eyes) with DME. All patients received intravitreal injections of aflibercept 0.05 ml (2 mg) in the operating room. The control group included paired eyes of patients into which no drugs were injected. Tonometry and OCT angiography were performed 5 and 30 minutes after the injection. Results: 5 minutes after the injection of aflibercept, an increase in IOP was noted in group 1 by 8.29 mm Hg (45.9%), in group 2 by 8.42 mm Hg (49.9%), accompanied by a decrease in optic nerve disc perfusion by 3.3% in both groups and the macular region by 6.97% and 2.71%, respectively. After 30, the pressure level decreased by 7.23 mm Hg (27.4%) and 7.88 (31%), but was higher than the initial values by 1.06 mm Hg (5.86%) and 0.54 mm Hg (3.2%), perfusion indices returned to their initial values. The vessel density of the optic disc and macular region before and after injection did not undergo statistically significant changes. Conclusions: Аnti-VEGF injection are accompanied by a short-term pronounced increase in IOP and a significant decrease in the perfusion of the optic nerve disc and, to a greater extent, the macular region. Monitoring the effect of anti-VEGF injection on the progression of glaucoma and the development of structural and functional changes should be decisive in the development of the regimen and duration of therapy for patients with DMЕ.