School of Medicine.
Department of Public Health Sciences.
J Glaucoma. 2019 Dec;28(12):1035-1040. doi: 10.1097/IJG.0000000000001382.
PRéCIS:: Intravitreal anti-vascular endothelial growth factor (VEGF) injections may accelerate glaucomatous change in patients with preexisting glaucoma or ocular hypertension (OHT). The safety of long-term injections in this specific population may be reflected in the need for additional glaucoma interventions.
The purpose of this study was to investigate whether repeated anti-VEGF injections accelerate structural and functional glaucomatous change in eyes with preexisting glaucoma or OHT.
This is a retrospective, observational study of injected and noninjected fellow eyes. A total of 28 patients with preexisting glaucoma or OHT, who received ≥6 unilateral anti-VEGF injections for concurrent neovascular retinal disease, were selected for chart review. Primary outcome measures were rate of visual field loss in dB/year, rate of change in retinal nerve fiber layer (RNFL) thickness in microns/year, and need for additional glaucoma medications, surgery, or laser.
The number of eyes requiring additional glaucoma surgery or laser was 8 of 28 (28.6%) for the injected group and 2 of 28 (7.1%) for the noninjected group. A significantly greater proportion of injected eyes required invasive glaucoma intervention (P=0.034). Average rate of decline in mean deviation and change in pattern standard deviation were both significantly greater in injected eyes (P=0.029; P=0.019). Estimated mean rate of global retinal nerve fiber layer change was -4.27 µm/y for the injected group and -1.17 µm/y for the noninjected group and was significant only for injected eyes (P=0.014). Only the superior quadrant exhibited thinning that was significantly different between groups (P=0.030).
Intravitreal injections were associated with accelerated functional and structural glaucoma-like change in susceptible eyes. Clinicians should assess the need for glaucoma medications or other interventions over the course of anti-VEGF therapy.
目的：本研究旨在探讨重复抗 VEGF 注射是否会加速存在青光眼或眼高压（OHT）的患眼出现结构性和功能性青光眼改变。
材料与方法：这是一项回顾性、观察性研究，研究对象为注射眼和未注射眼。共选择了 28 名患有青光眼或 OHT 的患者，这些患者因同时患有新生血管性视网膜疾病而接受了至少 6 次单侧抗 VEGF 注射。对图表进行了回顾性分析，主要观察指标为每年 dB 的视野丧失率、每年 µm 的视网膜神经纤维层（RNFL）厚度变化率，以及是否需要额外的青光眼药物、手术或激光治疗。
结果：在注射组中，需要进行额外青光眼手术或激光治疗的眼数为 28 只眼中的 8 只（28.6%），而非注射组中则为 28 只眼中的 2 只（7.1%）。注射组中需要进行侵入性青光眼干预的比例显著更高（P=0.034）。注射组的平均偏差下降率和模式标准差变化率均显著大于非注射组（P=0.029；P=0.019）。注射组的全球视网膜神经纤维层估计平均变化率为-4.27 µm/y，而非注射组为-1.17 µm/y，仅在注射组中具有统计学意义（P=0.014）。只有上象限的变薄在两组之间存在显著差异（P=0.030）。
结论：玻璃体内注射与易感眼中加速的功能性和结构性青光眼样改变相关。在抗 VEGF 治疗过程中，临床医生应评估是否需要使用青光眼药物或其他干预措施。
