Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
Am J Ophthalmol. 2021 Jun;226:206-216. doi: 10.1016/j.ajo.2020.12.016. Epub 2020 Dec 24.
This study evaluated whether the rate of retinal nerve fiber layer (RNFL) thinning is faster in eyes receiving intravitreal injections than in fellow uninjected eyes among patients suspected of having or confirmed to have glaucoma and exudative age-related macular degeneration (AMD).
Retrospective comparative cohort study.
Patients with a diagnosis of unilateral exudative AMD and confirmed to have or suspected of having glaucoma in both eyes receiving unilateral intravitreal injections were identified. Those with ≥3 RNFL optical coherence tomography scans and ≥6 injections were included in the study. Rates of RNFL thinning in the injected eye versus the uninjected eye were estimated using linear mixed models. The main outcome measurement was the differences in rates of RNFL thinning in the injected versus the fellow uninjected eye. The effects of postinjection elevation of intraocular pressure (IOP), injection frequency, and number of injections were also evaluated.
A total of 53 patients met the inclusion criteria, receiving 26.4 ± 15.9 intravitreal injections. The average rate of RNFL thinning in uninjected eyes was -0.620 μm/year (P = .029). Injected eyes had an additional incremental loss of -0.385 μm/year, but this value was not statistically significant (95% confidence interval [CI]: -1.147 to 0.379 μm/year; P = .324). Subgroup analysis with only glaucoma patients (n = 33) also demonstrated a nonsignificant effect of injections (-0.568 μm/year; 95% CI: -1.454 to 0.319 μm/year; P = .212). Postinjection IOP elevation, injection frequency, and total number of injections were not associated with faster RNFL loss.
Among exudative AMD patients with glaucoma or suspected of having glaucoma, the rate of RNFL thinning in eyes receiving intravitreal injections did not significantly differ from that of fellow uninjected eyes.
本研究旨在评估在怀疑或确诊患有青光眼以及渗出性年龄相关性黄斑变性（AMD）的患者中，接受玻璃体内注射的眼与未接受注射的对侧眼相比，视网膜神经纤维层（RNFL）变薄的速度是否更快。
回顾性比较队列研究。
确定单侧渗出性 AMD 诊断并在双眼均确诊或怀疑患有青光眼的患者中，接受单侧玻璃体内注射。纳入至少有 3 次 RNFL 光学相干断层扫描（OCT）和≥6 次注射的患者。使用线性混合模型估计注射眼与未注射眼的 RNFL 变薄率。主要观察指标为注射眼与对侧未注射眼的 RNFL 变薄率差异。还评估了注射后眼压（IOP）升高、注射频率和注射次数的影响。
共有 53 名患者符合纳入标准，共接受 26.4±15.9 次玻璃体内注射。未注射眼的平均 RNFL 变薄率为-0.620μm/年（P=0.029）。注射眼的额外增量损失为-0.385μm/年，但这一数值无统计学意义（95%置信区间[CI]：-1.147 至 0.379μm/年；P=0.324）。仅纳入青光眼患者（n=33）的亚组分析也显示注射无显著影响（-0.568μm/年；95%CI：-1.454 至 0.319μm/年；P=0.212）。注射后 IOP 升高、注射频率和总注射次数与 RNFL 丢失速度加快无关。
在患有青光眼或疑似青光眼的渗出性 AMD 患者中，接受玻璃体内注射的眼与对侧未注射眼的 RNFL 变薄速度无显著差异。
