Bilateral intravitreal injections on the rise, study finds

PARIS — A retrospective study carried out in three large centers in France found that one-third of anti-VEGF injections to treat wet age-related macular degeneration and diabetes-related ocular conditions are currently performed bilaterally.

“Bilateral injection is not recommended by guidelines, except in specific cases. However, the exponential increase of macular pathologies requiring anti-VEGF treatment and affecting both eyes in most cases may lead to an increasingly frequent adoption of a bilateral protocol,” Typhaine Grenet, MD, said at the meeting of the French Society of Ophthalmology.

Typhaine Grenet

In the three centers involved, the Centre d’Imagerie et Laser and ophthalmology department of the Lariboisière hospital in Paris and the Avicenne hospital in Bobigny, a total of 1,504 injections were performed in 1 month

“The number of bilateral injections represented 49% of the total number in diabetic patients and 37% of the total number in patients with AMD. In a variable percentage, they were performed simultaneously or at an interval ranging between a few hours and 1 month,” Grenet said.

Concerns about simultaneous or short-interval treatments are related to the potential cumulative systemic effects of anti-VEGF agents, as well as to the risk of bilateral infection.

However, Grenet noted that systemic risks appear to be low in studies and that very few cases of bilateral infection have been reported.

“In a French study across 25 centers with a total number of 316,576 intravitreal injections performed, not a single case of bilateral endophthalmitis was reported,” she said.

This relatively small risk should be weighed against the potential positive impact of bilateral treatment on the socioeconomic cost and hospital burden of intravitreal anti-VEGF procedures, she said. - by Michela Cimberle

Disclosure: Grenet reports no relevant financial disclosures.