Alphavision Augenzentrum, Bremerhaven, Germany; Raghudeep Eye Hospital, Ahmedabad; MS Sudhalkar Medical Research Foundation, Baroda, India.
Alphavision Augenzentrum, Bremerhaven, Germany.
Indian J Ophthalmol. 2021 Feb;69(2):236-243. doi: 10.4103/ijo.IJO_1028_20.
To determine the effect of commonly used intravitreal agents on immediate and long-term IOP elevations and their association, if any, with glaucoma. Literature searches in PubMed and the Cochrane databased in January 2020 yielded 407 individual articles. Of these, 87 were selected for review based on our inclusion criteria. Based on the evidence provided, 20 were assigned level I, 27 level II, and 22 level III. Eight articles were rejected because of poor quality, insufficient clarity, or irrelevance based on standardized protocols set out by the American Academy of Ophthalmology. The studies that reported on short-term IOP elevation (i.e., between 0 and 60 min) showed that an immediate increase in IOP is seen in all patients who receive anti-VEGF agents or triamcinolone acetonide when measured between 0 and 30 min of intravitreal injection and that the IOP elevation decreases over time. The data on long-term IOP elevation were mixed; 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 of anti-VEGF agents, while the position of the implant vis-à-vis, the anterior chamber was important for steroid therapy. 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. However, some studies demonstrated RNFL thinning in patients receiving chronic anti-VEGF therapy. Most, if not all, intravitreal agents cause ocular hypertension, both in the short term and long term. The functional consequences of these observations are not very clear.
为了确定常用的玻璃体内药物对即时和长期眼压升高的影响及其相关性，如果有的话，与青光眼的关系。2020 年 1 月，在 PubMed 和 Cochrane 数据库中进行了文献检索，共获得了 407 篇文章。根据我们的纳入标准，其中 87 篇被选为审查。根据提供的证据，20 篇被评为一级，27 篇被评为二级，22 篇被评为三级。有 8 篇文章因质量差、清晰度不够或根据美国眼科学会制定的标准化方案不相关而被拒绝。报告短期眼压升高（即 0 至 60 分钟）的研究表明，所有接受抗 VEGF 药物或曲安奈德治疗的患者在玻璃体内注射后 0 至 30 分钟内眼压均会立即升高，眼压随时间逐渐降低。关于长期眼压升高的数据则存在差异；在注射抗 VEGF 药物之前使用青光眼药物、前房穿刺、玻璃体反流、注射间隔时间延长和眼轴长度延长与注射后眼压升高降低相关，而植入物相对于前房的位置对类固醇治疗很重要。眼压升高与玻璃体内注射类型、玻璃体内注射次数、预先存在的青光眼以及注射前眼球减压之间的关系的数据存在差异。在本评估中审查的研究中没有眼压升高与青光眼发病或进展相关的数据。然而，一些研究表明，接受慢性抗 VEGF 治疗的患者视网膜神经纤维层变薄。如果不是所有的话，大多数玻璃体内药物都会引起短期和长期的眼压升高。这些观察结果的功能后果尚不清楚。
