Department of Ophthalmology, Izzet Baysal Training and Research Hospital, Abant Izzet Baysal University, Bolu.
Department of Ophthalmology, Gazi University Medical School, Ankara.
J Glaucoma. 2020 Oct;29(10):981-988. doi: 10.1097/IJG.0000000000001600.
PRéCIS:: Intravitreal anti-vascular endothelial growth factor therapy resulted in sustained elevation of intraocular pressure (IOP) in 18.6% of patients with coexisting age-related macular degeneration and pseudoexfoliation (PXF) syndrome. The development of sustained elevation of IOP after ~19 injections reflected the cumulative effect of anti-vascular endothelial growth factor injections on IOP.
The purpose of this study was to compare the long-term effect of intravitreal ranibizumab (IVR) and intravitreal bevacizumab (IVB) therapies on IOP in patients with and without PXF syndrome.
This was a retrospective comparative study.
Data from 412 eyes of 206 patients diagnosed with unilateral neovascular age-related macular degeneration, treated with IVR or IVB, and followed-up for at least 6 months, were retrospectively reviewed. Seventy treated and 70 untreated fellow eyes of 70 patients with bilateral PXF syndrome, and 136 treated and 136 untreated fellow eyes of 136 patients without PXF syndrome were included in this study. Demographic information, clinical findings, total number of IVR and IVB injections, and IOP values at each visit were recorded. Sustained elevation of IOP (SE-IOP) was defined as either an IOP >21 mm Hg or a ≥5 mm Hg increase in IOP from baseline for at least 2 consecutive visits. Baseline and final IOP values in each group were compared using the paired sample t test, and IOP changes in the groups were compared using split-plot analysis of variance. Multivariate logistic regression analysis was used to evaluate the influence of variables on the development of SE-IOP.
The mean (±SD) age of the patients was 77.53±3.78 years (range, 70 to 83 y), and the mean follow-up was 28.50±16.51 months (range, 6 to 58 mo). The mean number of injections was 15.56±8.01 (range, 5 to 36). The mean baseline and final IOP in treated eyes were 14.82±3.08 and 16.50±3.11 mm Hg, respectively (P<0.001). A higher incidence of SE-IOP and higher final IOP values were observed in PXF-positive eyes receiving IVB compared with the other groups. Seven of the patients required antiglaucomatous treatment. Multivariate logistic regression analysis revealed an increased odds ratio (4.90; P=0.016) of SE-IOP in PXF-positive eyes compared with PXF-negative eyes.
IVB therapy may cause greater increases in IOP in patients with PXF syndrome. The co-accumulation of PXF material and bevacizumab particles on the trabecular meshwork should be further investigated.
本研究旨在比较玻璃体内注射雷珠单抗（IVR）和玻璃体内注射贝伐单抗（IVB）治疗伴或不伴假性剥脱（PXF）综合征的患者的眼压（IOP）的长期效果。
这是一项回顾性比较研究。
回顾性分析了 412 只眼 206 例单侧新生血管性年龄相关性黄斑变性患者的资料，这些患者接受了 IVR 或 IVB 治疗，随访时间至少为 6 个月。本研究纳入了 70 例双侧 PXF 综合征患者的 70 只治疗眼和 70 只未治疗眼，以及 136 例无 PXF 综合征患者的 136 只治疗眼和 136 只未治疗眼。记录了人口统计学信息、临床发现、IVR 和 IVB 注射总数以及每次就诊时的 IOP 值。将持续性眼压升高（SE-IOP）定义为 IOP ＞21mmHg 或与基线相比 IOP 升高≥5mmHg，且至少连续 2 次就诊。使用配对样本 t 检验比较各组的基础值和终值，使用拆分图方差分析比较各组的 IOP 变化。采用多变量逻辑回归分析评估变量对 SE-IOP 发展的影响。
患者的平均（±SD）年龄为 77.53±3.78 岁（范围，70 至 83 岁），平均随访时间为 28.50±16.51 个月（范围，6 至 58 个月）。平均注射次数为 15.56±8.01（范围，5 至 36）。治疗眼的平均基础值和终值 IOP 分别为 14.82±3.08 和 16.50±3.11mmHg（P＜0.001）。与其他组相比，PXF 阳性眼接受 IVB 治疗后 SE-IOP 发生率更高，终值 IOP 更高。7 例患者需要抗青光眼治疗。多变量逻辑回归分析显示，与 PXF 阴性眼相比，PXF 阳性眼发生 SE-IOP 的优势比（OR）为 4.90（P=0.016）。
IVB 治疗可能会导致 PXF 综合征患者的 IOP 升高更大。应进一步研究 PXF 物质和贝伐单抗颗粒在小梁网的共同堆积。
