Department for Ophthalmology, Kepler University Hospital, Johannes Kepler University, Linz, Austria.
University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany.
Acta Ophthalmol. 2019 Sep;97(6):e927-e932. doi: 10.1111/aos.14098. Epub 2019 Mar 27.
Intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) is the standard treatment for neovascular age-related macular degeneration (AMD). As VEGF is a physiological key player for regulating retinal vascular tone, questions have been raised whether the application of anti-VEGF could induce alterations in ocular perfusion.
The study included 20 eyes from 20 Caucasian patients with unilateral neovascular AMD and 20 fellow eyes. All eyes were treated with standard intravitreal injection of aflibercept (IVA). Measurements of blood flow at the optic nerve head (ONH) and the choroid were performed with laser speckle flowgraphy (LSFG). The intraocular pressure (IOP), systolic and diastolic blood pressure, heart rate, mean arterial pressure (MAP) and ocular perfusion pressure (OPP) were analysed. Measurements were performed at baseline and repeated immediately after the injection and 30 and 45 min later.
Mean time between injection of aflibercept and first follow-up was 8:56 ± 4:25 min. The injection led to significant rise in IOP. In the injected eyes, mean blur rate (MBR, i.e. a relative measure of perfusion and the main outcome parameter of LSFG) within the major vessels of the ONH as well as at the entire ONH region decreased significantly (p < 0.001). No change in MBR was observed in the fellow eye. Choroidal blood flow was maintained stable in both eyes.
Intravitreal injection of aflibercept (IVA) led to a short-term reduction in perfusion only in the treated eye. This was independent from IOP, indicating a direct pharmacological effect. No changes in choroidal perfusion were observed during the first 45 min after the injection.
玻璃体内注射抗血管内皮生长因子（anti-VEGF）是治疗新生血管性年龄相关性黄斑变性（AMD）的标准方法。由于 VEGF 是调节视网膜血管张力的生理关键因素，因此有人质疑抗 VEGF 的应用是否会引起眼灌注的改变。
该研究纳入了 20 名单侧新生血管性 AMD 患者的 20 只眼和 20 只对侧眼。所有眼均接受标准玻璃体内注射阿柏西普（IVA）治疗。使用激光散斑血流仪（LSFG）测量视神经头（ONH）和脉络膜的血流。分析眼压（IOP）、收缩压和舒张压、心率、平均动脉压（MAP）和眼灌注压（OPP）。在基线时以及注射后即刻、30 分钟和 45 分钟时进行测量。
阿柏西普注射和首次随访之间的平均时间为 8:56 ± 4:25 分钟。注射导致 IOP 显著升高。在注射眼，ONH 主要血管内以及整个 ONH 区域的平均模糊率（MBR，即灌注的相对测量值，也是 LSFG 的主要观察指标）显著降低（p < 0.001）。对侧眼的 MBR 没有变化。双眼脉络膜血流保持稳定。
玻璃体内注射阿柏西普（IVA）仅导致治疗眼的短期灌注减少。这与 IOP 无关，表明存在直接的药理学作用。在注射后 45 分钟内，未观察到脉络膜灌注的变化。
