Bakri Sophie J, Risco Miguel, Edwards Albert O, Pulido Jose S
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Am J Ophthalmol. 2009 Jul;148(1):66-9.e1. doi: 10.1016/j.ajo.2009.02.013. Epub 2009 Apr 29.
To report the outcomes and complications of bilateral simultaneous intravitreal injections performed in the office.
Retrospective case series.
Records of 35 patients receiving simultaneous bilateral intravitreal injections between November 2007 and November 2008 were reviewed. Data collected included indication for injection, preinjection and postinjection intraocular pressure (IOP), preinjection and postinjection visual acuity (VA), and complications/complaints after each injection.
A total of 208 injections were administered to 35 patients, with a mean of 5.9 injections per patient (range, 2 to 14; standard deviation [SD], 3.68). One hundred and thirty-three eyes received bevacizumab (Avastin; Genentech Inc, South San Francisco, California, USA) alone, 14 received bevacizumab plus preservative-free intravitreal triamcinolone or Triescence (Kenalog; Bristol-Myers Squibb Co, New York, New York, USA), 56 received ranibizumab (Lucentis; Genentech Inc), and 5 received bevacizumab plus dexamethasone (Decadron; Merck, Whitehouse Station, New Jersey, USA). Mean time of postinjection follow-up was 39 days. Postinjection VA follow-up measurements were available for 194 injections. The indication for initiating therapy was choroidal neovascularization from age-related macular degeneration (49 eyes), diabetic macular edema (ME) (13 eyes), proliferative diabetic retinopathy (4 eyes), ME attributable to retinal vein occlusion (2 eyes), and ME attributable to autoimmune retinopathy (2 eyes). The mean VA before each injection was 20/96 and at the next follow-up was 20/91 (P = .40). One patient had a painless, culture-negative endophthalmitis in 1 eye 3 days after bilateral bevacizumab; at 1 year VA improved from 20/400 to 20/80.
Simultaneous bilateral intravitreal injections in the office are well tolerated. A separate povidone-iodine preparation, speculum, needle, and syringe were used for each eye. None of the patients requested alternating unilateral injections, after receiving bilateral injections. Patients should be counseled as to the risk of complications.
报告在诊室进行双眼同时玻璃体腔内注射的结果及并发症。
回顾性病例系列。
回顾2007年11月至2008年11月期间35例接受双眼同时玻璃体腔内注射患者的记录。收集的数据包括注射指征、注射前和注射后眼压（IOP）、注射前和注射后视力（VA）以及每次注射后的并发症/主诉。
35例患者共接受208次注射，平均每位患者5.9次注射（范围2至14次；标准差[SD]为3.68）。133只眼仅接受贝伐单抗（阿瓦斯汀；基因泰克公司，美国加利福尼亚州南旧金山），14只眼接受贝伐单抗加无防腐剂玻璃体腔注射曲安奈德或曲安奈德（凯内洛；百时美施贵宝公司，美国纽约），56只眼接受雷珠单抗（兰尼单抗；基因泰克公司），5只眼接受贝伐单抗加地塞米松（德卡德龙；默克公司，美国新泽西州怀特豪斯站）。注射后平均随访时间为39天。194次注射有注射后VA随访测量数据。开始治疗的指征为年龄相关性黄斑变性引起的脉络膜新生血管（49只眼）、糖尿病性黄斑水肿（ME）（13只眼）、增殖性糖尿病视网膜病变（4只眼）、视网膜静脉阻塞所致ME（2只眼）以及自身免疫性视网膜病变所致ME（2只眼）。每次注射前平均视力为20/96，下次随访时为20/91（P = 0.40）。1例患者在双眼注射贝伐单抗3天后1只眼发生无痛性、培养阴性的眼内炎；1年后视力从20/400提高到20/80。
诊室双眼同时玻璃体腔内注射耐受性良好。每只眼使用单独的聚维酮碘制剂、窥器、针头和注射器。接受双眼注射后，没有患者要求交替进行单侧注射。应向患者告知并发症风险。
