| Resumo: | Purpose: To evaluate the association between repeated intravitreal injections and variation in glaucoma-related parameters in eyes with glaucoma spectrum diseases (GSD). Methods: Retrospective longitudinal study of São João University Hospital's patients with ocular hypertension (OHT), glaucoma suspects (GS) or definite glaucoma that received ≥8 study period intravitreal injections per eye and had ≥2 retinal nerve fiber layer thickness (RNFL) measurements obtained by spectral-domain optical coherence tomography (SD-OCT) ≥12 months apart. Our primary outcome was the variation in RNFL thickness. Linear mixed effects models were constructed, including a multivariable model. Results: 112 eyes from 100 patients were included. Average baseline age was 71.05±10.88 years with a follow-up of 40.41±23.58 months. 42% of eyes had primary open angle glaucoma (POAG) or normotensional glaucoma (NTG), 35.7% OHT or GS, 16.1% secondary open-angle glaucoma (OAG) and 6.3% angle-closure glaucoma (ACG). RNFL thickness decreased significantly from 85.97±20.14 to 79.70±20.69 μm (p<0.001; -2.10±7.36 μm/year), with no significant changes detected in visual fields' mean deviation (MD) (p=0.382). Intraocular pressure (IOP) decreased significantly from 18.64±7.10 to 15.05±4.04 mmHg (p<0.001). There was a significant difference in RNFL variation between GSD, with higher RNFL loss in eyes with secondary OAG (-11.24±16.95 μm), followed by POAG/NTG (-8.64±14.39 μm), ACG (-8.13±11.08 μm) and OHT/GS (-0.94±15.69 μm) (p<0.001). In a multivariable model, higher baseline RNFL thickness (p<0.001), higher baseline IOP (p<0.001), lower central corneal thickness (p<0.001) and type of GSD (p=0.017) significantly predicted higher RNFL loss. Conclusions: Routine optic nerve evaluations should be performed in patients with GSD undergoing repeated intravitreal injections, especially if glaucomatous damage is already present.
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