Risk of ptosis following eyelid speculum assisted intravitreal anti-VEGF injections

Abstract Purpose Intravitreal injections are essential for treating retinal diseases. This study aims to assess the impact of repeated intravitreal anti-VEGF injections using an eyelid speculum on the risk of ptosis development. Methods This single-center, retrospective chart review included 114 patients (228 eyes) who received at least three unilateral intravitreal anti-VEGF injections. Patient demographics, clinical characteristics, and MRD1 and MRD2 of the injected and the fellow eyes were analyzed. A multivariate linear regression model was constructed to identify predictors of MRD1 in the injected eye. Results The study cohort had a mean age of 75.18 ± 0.98 years, with 57% female patients. On average, patients received 16.92 ± 1.18 injections. At the final follow-up, no significant difference was observed in mean MRD1 between injected and fellow eyes (2.85 ± 0.11 mm vs. 2.90 ± 0.11 mm, p = 0.445). Multivariate regression analysis identified MRD1 of the fellow eye as the only significant predictor of MRD1 in the injected eye (β = 0.769, p < 0.001). Conclusion The repeated use of an eyelid speculum during intravitreal anti-VEGF injections does not significantly contribute to ptosis development. MRD1 tends to be similar between the injected and non-injected eye, suggesting that intrinsic factors may play a more crucial role in determining eyelid position than the mechanical effects of the procedure.