Ophthalmic Consultants of Boston, Boston, Massachusetts.
Department of Ophthalmology, University of Washington, Seattle, Washington.
Ophthalmology. 2019 Apr;126(4):611-622. doi: 10.1016/j.ophtha.2018.11.019. Epub 2018 Nov 22.
To assess the effect of intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents on immediate and long-term intraocular pressure (IOP) elevation and glaucoma.
Literature searches of the PubMed and Cochrane databases, last conducted in April 2018, yielded 253 unique citations. Of these, 41 met the inclusion criteria and were rated according to the strength of evidence. Two articles were rated level I, 17 were rated level II, and 15 were rated level III; an additional 7 were excluded because of poor study design and lack of relevance to the topic under evaluation.
The studies that reported on short-term IOP elevation (i.e., between 0 and 60 minutes) showed that an immediate increase in IOP is seen in all patients when measured between 0 and 30 minutes of intravitreal injection and that the IOP elevation decreases over time. The data on long-term IOP elevation were mixed; 7 studies reported that between 4% and 15% of patients developed sustained elevation of IOP at 9 to 24 months after injection, whereas 6 studies found no long-term change in IOP from 1 to 36 months after injection. Pretreatment with glaucoma medications, anterior chamber tap, vitreous reflux, longer intervals between injections, and longer axial lengths were associated with lower IOP elevations after injection. Data were mixed on the relationship between IOP increase and the type of intravitreal injection, number of intravitreal injections, preexisting glaucoma, and globe decompression before injection. There were no data on the onset or progression of glaucoma in the studies reviewed in this assessment.
Intravitreal injection of anti-VEGF agents results in an immediate and transient increase in IOP. A long-term increase in IOP also may be seen, and further studies are needed to determine at-risk populations. Although there is some suggestion in the literature, there is currently insufficient data to determine the impact of intravitreal anti-VEGF injections on glaucoma progression. Although pretreatment with glaucoma medications, performing anterior chamber paracentesis, or increasing the interval between injections may reduce the impact of transient IOP elevation, the clinical significance and associated risks of these interventions are unknown.
评估玻璃体内注射抗血管内皮生长因子（VEGF）药物对即时和长期眼内压（IOP）升高和青光眼的影响。
对 2018 年 4 月之前在 PubMed 和 Cochrane 数据库中进行的文献检索共获得 253 个独特的引文。其中，41 项符合纳入标准，并根据证据强度进行了评估。两篇文章被评为一级，17 篇为二级，15 篇为三级；另外 7 篇由于研究设计不佳且与评估主题无关而被排除在外。
报告短期 IOP 升高（即 0 至 60 分钟之间）的研究表明，所有患者在玻璃体内注射后 0 至 30 分钟之间测量时都会出现 IOP 立即升高，并且 IOP 升高会随时间降低。关于长期 IOP 升高的数据则较为混杂；7 项研究报告称，在注射后 9 至 24 个月，有 4%至 15%的患者出现持续的 IOP 升高，而 6 项研究发现，在注射后 1 至 36 个月，IOP 没有长期变化。注射前使用青光眼药物、前房穿刺、玻璃体反流、注射间隔时间延长和眼轴较长与注射后 IOP 降低相关。IOP 升高与玻璃体内注射类型、玻璃体内注射次数、青光眼前期以及注射前眼球减压之间的关系的数据混杂。在本次评估中审查的研究中，没有关于青光眼发作或进展的数据。
玻璃体内注射抗 VEGF 药物会导致 IOP 立即且短暂升高。也可能会出现长期 IOP 升高，需要进一步研究来确定高危人群。尽管文献中有一些提示，但目前尚无足够的数据来确定玻璃体内抗 VEGF 注射对青光眼进展的影响。虽然在注射前使用青光眼药物、进行前房穿刺术或增加注射间隔时间可能会降低短暂 IOP 升高的影响，但这些干预措施的临床意义和相关风险尚不清楚。
