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Related Experiment Video

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Corneal Endothelial Cell Changes Associated with Multiple Intravitreal Injections.

Mariaelena Malvasi1, Pietro Mangiantini1, Floriana Testa1

  • 1Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy.

Journal of Current Ophthalmology
|June 25, 2025
PubMed
Summary

Multiple intravitreal injections for posterior eye conditions negatively impact corneal endothelial cells. More injections correlate with reduced cell density and hexagonality, and increased cell size variation, affecting corneal health.

Keywords:
Anti-vascular endothelial growth factorCorneal endotheliumDexamethasone implantEndothelial cell countIntravitreal injections

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Area of Science:

  • Ophthalmology
  • Corneal Science
  • Retinal Diseases

Background:

  • Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) and steroids are common treatments for posterior segment pathologies.
  • The long-term effects of repeated injections on the corneal endothelium are not fully understood.

Purpose of the Study:

  • To investigate the impact of multiple anti-VEGF or steroid intravitreal injections on corneal endothelial cell characteristics.
  • To assess changes in endothelial cell density (ECD), cell size variation (CV), and hexagonality (HEX%) following repeated injections.

Main Methods:

  • A cross-sectional study involving 108 eyes treated with multiple intravitreal injections for macular edema.
  • Corneal endothelium and thickness were measured using a corneal endothelial microscope.
  • Multiple linear regression analysis was used to evaluate the relationship between the number of injections, age, and endothelial parameters.

Main Results:

  • A significant inverse relationship was found between the total number of injections and endothelial cell density (ECD) and hexagonality (HEX%).
  • Conversely, a direct relationship was observed between the number of injections and the coefficient of variation (CV) of cell size.
  • Intraocular pressure (IOP) showed a mean increase of +6.4 mmHg 30 minutes post-injection.

Conclusions:

  • The cumulative number of intravitreal injections is associated with detrimental changes in the corneal endothelium.
  • Increased injections lead to lower ECD, reduced HEX%, and higher CV, indicating endothelial cell damage or stress.
  • These findings highlight the importance of monitoring corneal health in patients undergoing long-term intravitreal injection therapy.