Baeteman C, Hoffart L, Galland F, Ridings B, Conrath J
Service d'ophtalmologie, Hôpital de Vision, Timone, Marseille.
J Fr Ophtalmol. 2009 May;32(5):309-13. doi: 10.1016/j.jfo.2009.04.001. Epub 2009 May 17.
Prescription of anti-VEGF treatments have increased substantially over the past few years in treatment of wet age-related macular degeneration. We report the occurrence of macular hemorrhages after one year of use of anti-VEGF intravitreal injections, mainly for subfoveal choroidal neovascularization.
Four hundred forty five injections were given over one year (from 15 March 2007 to 15 March 2008), for age-related macular degeneration, retinal vascular occlusion, diabetic retinopathy, neovascular glaucoma, and idiopathic macular choroidal neovascularization; distributed as follows: 11.5% Bevacizumab, 18.6% Pegaptanib, 19.3% Triamcinolone, and 50.6% Ranibizumab.
Six macular hemorrhages were observed, resulting in to a sharp decrease in visual acuity (20/400), with loss of five lines. All occurred after one injection of nonselective anti-VEGF (Ranibizumab) on already treated eyes (four previous injections on average, +/- photodynamic therapy). All were secondary to occult choroidal neovascularization or a large pigment epithelial detachment. Three patients presented a pigment epithelial tear.
Anti-VEGF intravitreal injections can lead to pigment epithelial tears in case of large pigment epithelial detachment, especially with a small feeder vessel or with large occult choroidal neovascularization. The authors discuss the possible implications of anti-VEGF when macular hematoma occurs: retraction of choroidal neovascularization and alteration of physiological retinal vascularization.
Macular hematoma affects visual prognosis in age-related macular degeneration. It may follow intravitreal anti-VEGF injection with large occult neovascularization, especially in previously treated eyes. Injection in large pigment epithelial detachment may cause a risk of epithelial tear. Other studies are necessary to evaluate the role of the nonselective anti-VEGF in the incidence of macular hematoma.
在过去几年中，抗VEGF治疗药物在湿性年龄相关性黄斑变性的治疗中的处方量大幅增加。我们报告了抗VEGF玻璃体内注射治疗一年后黄斑出血的发生情况，主要针对黄斑下脉络膜新生血管形成。
在一年时间内（从2007年3月15日至2008年3月15日）共进行了445次注射，用于治疗年龄相关性黄斑变性、视网膜血管阻塞、糖尿病性视网膜病变、新生血管性青光眼和特发性黄斑脉络膜新生血管形成；分布如下：贝伐单抗占11.5%，哌加他尼占18.6%，曲安奈德占19.3%，雷珠单抗占50.6%。
观察到6例黄斑出血，导致视力急剧下降（20/400），下降了5行。所有出血均发生在已接受治疗的眼睛上注射一次非选择性抗VEGF（雷珠单抗）之后（平均先前已注射4次，±光动力疗法）。所有出血均继发于隐匿性脉络膜新生血管形成或大的色素上皮脱离。3例患者出现色素上皮撕裂。
在存在大的色素上皮脱离的情况下，尤其是伴有小的滋养血管或大的隐匿性脉络膜新生血管形成时，玻璃体内注射抗VEGF可导致色素上皮撕裂。作者讨论了黄斑血肿发生时抗VEGF可能产生的影响：脉络膜新生血管退缩和视网膜生理性血管化改变。
黄斑血肿影响年龄相关性黄斑变性的视力预后。它可能继发于玻璃体内抗VEGF注射及大的隐匿性新生血管形成，尤其是在先前已接受治疗的眼睛中。在大的色素上皮脱离处注射可能导致上皮撕裂风险。需要进行其他研究以评估非选择性抗VEGF在黄斑血肿发生率中的作用。
