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Objective To investigate the effects of serial intravitreal injections (IVI) with anti-vascular endothelial growth factor (VEGF) on the ocular surface for diabetic patients.
Methods A self-controlled study was performed. One hundred fifty-six eyes of 78 diabetic patients with fundus vascular disease who received serial intravitreal injections of anti-VEGF drugs at least 6 times were enrolled in Henan Eye Hospital from June 2022 to June 2025. All were monocular patients, the fellow eye was used as a control. There were 47 cases (47 eyes) with diabetic macular edema, 15 cases (15 eyes) with retinal vein occlusion, 11 cases (11 eyes) with neovascular age-related macular degeneration, and 5 cases (5 eyes) with polypoidal choroidal vasculopathy. Corneal fluorescein staining (CFS) score, tear break-up time (TBUT), Schirmer Ⅰ test (SⅠT), central corneal sensation, Ocular Surface Diseases Index (OSDI) score, tear meniscus height (TMH), lipid layer thickness (LLT), meibomian gland (MG) loss and eyelid margin score were recorded and compared before and 1 month after the last IVI. This study adhered to the Declaration of Helsinki. The study protocol was approved by the Ethics Committee of Henan Eye Hospital (No. HNEEC-2022-42).
Results There were no significant differences in CFS score, TBUT, SⅠT, TMH, central corneal sensation or OSDI score before IVI (Z=-1.000, t=0.395, 1.085, 1.647, 1.349, 1.098; all P>0.05). The OSDI score in the IVI group was (13.72±5.38), which was lower than (15.09±5.41) in the control group after serial intravitreal injections ( t=2.834, P=0.006), but no significant differences were found in CFS score, TBUT, SⅠT, TMH or central corneal sensation (Z=0.707, t=1.618, 1.640, 1.596, 1.435; all P>0.05). There were no significant differences in LLT, upper MG loss, lower MG loss, upper or lower eyelid margin scores ( t=1.479, Z=1.414, 1.633, 1.069, 1.000; all P>0.05) before IVI. The upper and lower MG loss was less in the IVI group than in the control group after IVI (Z=2.353, 2.985; both P<0.05). No significant differences were found between treated and fellow eyes regarding LLT, upper or lower eyelid margin scores after IVI ( t=1.607, Z=1.291, 1.179; all P>0.05).
Conclusions Serial IVI with anti-VEGF treatment can relieve dry eye symptoms in diabetic patients, reduce MG loss, improve ocular surface function, and is well tolerated.