Morphometric changes in optic nerve head parameters in ocular hypertension induced by intravitreal administration of angiogenesis inhibitors

PURPOSE. To compare the changes in morphometric parameters of the optic nerve head (ONH) following intravitreal injections (IVI) of aflibercept in patients with natural and artificial lenses. METHODS. The study included 60 patients, divided into two groups: the control group, consisting of 30 patients with natural lenses, and the main group, consisting of 30 patients with intraocular lenses. All patients underwent three aflibercept IVIs at 4-week intervals, followed by a treat-and-extend regimen for one year. Intraocular pressure (IOP) was measured with the iCare Pro tonometer before IVI, and 1 minute and 60 minutes after IVI. All patients underwent optical coherence tomography (OCT) of the ONH, using radial (star-shaped) scans. Horizontal slices of the ONH were analyzed. RESULTS. By the end of the observation period, both groups had received a comparable number of IVIs. The average IOP increase 1 minute after IVI exceeded 15 mm Hg compared to baseline in both groups. In the control group, one year after treatment, an increase in optic disc cup width was observed, with the median increasing by 15 μm (p<0.001). The median cup depth increased by 8 μm (p<0.001). In the main group, cup width also increased, with a median increase of 6 μm (p<0.001), and cup depth increased by 4 μm (p<0.001). These changes were statistically more pronounced in the control group compared to the main group. In both groups, the Bruch’s membrane opening diameter and the distance to the anterior surface of the lamina cribrosa did not significantly change throughout the observation period. CONCLUSION. A series of acute IOP elevations due to repeated IVIs over the course of a year is associated with an increase in the width and depth of optic disc cup, which is more pronounced in patients with natural lenses.