Blepharoptosis After Intravitreal Anti-VEGF Injections: A Prospective Study

The purpose is to objectively evaluate changes in upper eyelid height and contour after intravitreal injections.

A prospective, observational, multicentre study was carried out on naive patients undergoing unilateral intravitreal injection of anti-vascular endothelial growth factor from January 2021 to February 2023. Injected eyes were considered cases, and noninjected contralateral eyes were used as controls. Data collected included demographics, cause of injection, drug used, use of a speculum, history of previous topical treatments, postinjection prophylaxis, and complications. A photograph was taken at baseline and at 6 and 12 months. ImageJ software was used to fit Bézier lines to the eyelid contour and upper eyelid margin reflex distance (MRD) 1, and 7 mid-pupil to eyelid margin distances were calculated. Clinically significant ptosis was defined as a decrease in MRD1 of ≥0.5 mm from baseline. ANOVA was used to compare MRD1 and mid-pupil to eyelid margin distance values. The p values of <0.05 were considered significant.

Sixty-one patients (mean age, 74.61 ± 12.30 years; 59% women) were included. Fifty-three (86.9%) patients received aflibercept, and 8 (13.1%) received ranibizumab. A speculum was used in all cases. Complications included 1 case (1.6%) of mild subconjunctival hemorrhage and 1 case (1.6%) of mild corneal epithelial defect. In injected eyes, MRD1 decreased by 0.43 ± 0.59 mm (6 months) and 0.60 ± 0.61mm (12 months; p < 0.01), as well as all mid-pupil to eyelid margin distances ( p < 0.05). Clinically significant ptosis occurred in 57.4% of patients at 12 months. No significant changes were observed in control eyes.

Repeated anti-vascular endothelial growth factor intravitreal injections are associated with a decrease in MRD1 and upper eyelid contour at 6 and 12 months. The use of a speculum may contribute to postinjection ptosis.