Retinal nerve fiber layer thickness in patients receiving chronic anti-vascular endothelial growth factor therapy

Am J Ophthalmol. 2010 Oct;150(4):558-561.e1. doi: 10.1016/j.ajo.2010.04.029.


Purpose: To evaluate the effects of multiple intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents on the thickness of the retinal nerve fiber layer (RNFL) in patients with wet age-related macular degeneration (ARMD).

Design: Retrospective, observational, consecutive case series of patients diagnosed with wet ARMD.

Methods: Forty-one eyes of 37 consecutive patients (25 female and 12 male; mean age 79.2 ± 8.7 years) who underwent treatment with pegaptanib, bevacizumab, and/or ranibizumab for ARMD followed by sequential RNFL thickness measurement by optical coherence tomography (OCT) were studied. Patients were included in the analyses if they had greater than 10 total anti-VEGF injections, RNFL measurements prior to the first injection, and at least 12 months of follow-up. Patients were divided into 3 groups depending on which anti-VEGF agent(s) they received. The OCT RNFL measurements at the initial and final follow-up were used for analyses.

Results: Average follow-up for all patients was 27.0 ± 9.7 months and they received an average of 16.0 ± 5.5 intravitreal injections. The average RNFL thickness at presentation was 92.4 ± 15.2 μm and at last follow-up was 93.8 ± 15.2 μm (P = .68). There were no statistically significant differences in RNFL measurements when comparing between individual anti-VEGF treatment groups.

Conclusion: Long-term treatment with anti-VEGF agents did not lead to significant changes in RNFL thickness in a patient population with wet ARMD. Despite the possibility of repeated intraocular pressure (IOP) fluctuations after intravitreal injections and known neurotrophic properties of VEGF in the eye, chronic therapy with intravitreal anti-VEGF agents does not appear to adversely affect RNFL thickness. Further prospective studies with longer follow-up are needed to corroborate the findings of this study.

MeSH terms

  • Aged
  • Angiogenesis Inhibitors / administration & dosage*
  • Angiogenesis Inhibitors / adverse effects
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / adverse effects
  • Antibodies, Monoclonal, Humanized
  • Aptamers, Nucleotide / administration & dosage
  • Aptamers, Nucleotide / adverse effects
  • Bevacizumab
  • Female
  • Humans
  • Injections
  • Male
  • Nerve Fibers / drug effects
  • Nerve Fibers / pathology*
  • Optic Disk / drug effects
  • Optic Disk / pathology*
  • Ranibizumab
  • Retinal Ganglion Cells / drug effects
  • Retinal Ganglion Cells / pathology*
  • Retreatment
  • Retrospective Studies
  • Tomography, Optical Coherence
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors*
  • Vitreous Body
  • Wet Macular Degeneration / drug therapy*


  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Aptamers, Nucleotide
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • pegaptanib
  • Bevacizumab
  • Ranibizumab