Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
J Glaucoma. 2021 May 1;30(5):451-458. doi: 10.1097/IJG.0000000000001833.
A higher "corneal resistance factor" (CRF) was associated with greater intraocular pressure (IOP) elevation after intravitreal injection of bevacizumab. Both higher "corneal hysteresis" (CH) and CRF were associated with more rapid IOP recovery postinjection.
The purpose of this study was to evaluate the relationship between measurable corneal biomechanical properties and acute IOP elevation after rapid intraocular volume expansion from the routine intravitreal injection.
A total of 100 patients necessitating unilateral intravitreal injection with 0.05 mL of bevacizumab for retinal pathology were analyzed before injection with Goldmann Applanation Tonometry to measure IOP, Ocular Response Analyzer (ORA) to measure corneal biomechanical properties, and optical biometry to calculate globe measurements. IOP and ORA were measured again within 5 minutes of the injection and then IOP measurements were taken every 10 minutes until the IOP was ≤150% of the preinjection IOP. Linear regression and logistic regression were used to test variables associated with acute IOP increase. A Cox proportional hazard model accounting for preinjection IOP and postinjection IOP was used to test the effect of CH or CRF on the time required to return to 150% of baseline IOP.
Higher CRF was associated with greater immediate postinjection IOP (P=0.026) elevation. A preinjection IOP>15.5 mm Hg moderately predicted postinjection IOP≥35 mm Hg (area under the receiver operating characteristics curve=0.74). A preinjection IOP>18.5 mm Hg combined with CH poorly predicted postinjection IOP>50 mm Hg (area under the receiver operating characteristics curve=0.67). A higher CH [hazard ratio (HR)=1.24; 95% confidence interval (CI)=1.08-1.42; P=0.002] and preinjection IOP (HR=1.16; 95% CI=1.09-1.22; P<0.001), along with a lower immediate postinjection IOP (HR=0.93; 95% CI=0.90-0.95; P<0.001), were each independently associated with quicker IOP recovery postinjection. Similar results were seen in the Cox model examining CRF and IOP recovery.
Higher CRF and preinjection IOP were independently associated with greater postinjection IOP elevations. ORA metrics did not greatly strengthen the prediction of patients who would have postinjection IOP>50 mm Hg. Higher CH and CRF were associated with faster IOP recovery after intravitreal injection, demonstrating the dynamic relationship between ocular biomechanical properties and aqueous outflow pathways.
玻璃体内注射贝伐单抗后，较高的“角膜阻力因子”（CRF）与眼压（IOP）升高有关。较高的“角膜滞后量”（CH）和 CRF 与注射后 IOP 恢复较快有关。
本研究旨在评估常规玻璃体内注射引起的急性眼内容积扩张后，可测量的角膜生物力学特性与急性眼压升高之间的关系。
100 例因视网膜病变需要单侧玻璃体内注射 0.05 mL 贝伐单抗的患者，在注射前用 Goldmann 压平眼压计测量眼压，用 Ocular Response Analyzer（ORA）测量角膜生物力学特性，用光学生物测量仪计算眼球测量值。注射后 5 分钟内再次测量 IOP 和 ORA，然后每隔 10 分钟测量一次 IOP，直到 IOP 低于注射前 IOP 的 150%。线性回归和逻辑回归用于测试与急性眼压升高相关的变量。采用 Cox 比例风险模型，考虑注射前 IOP 和注射后 IOP，测试 CH 或 CRF 对恢复至基线 IOP 的 150%所需时间的影响。
较高的 CRF 与注射后即刻眼压升高（P=0.026）有关。注射前 IOP>15.5mmHg 可中度预测注射后 IOP≥35mmHg（受试者工作特征曲线下面积=0.74）。注射前 IOP>18.5mmHg 结合 CH 可较差地预测注射后 IOP>50mmHg（受试者工作特征曲线下面积=0.67）。较高的 CH[风险比（HR）=1.24；95%置信区间（CI）=1.08-1.42；P=0.002]和注射前 IOP（HR=1.16；95%CI=1.09-1.22；P<0.001），以及较低的即刻注射后 IOP（HR=0.93；95%CI=0.90-0.95；P<0.001），均与注射后眼压恢复较快独立相关。在 Cox 模型中检查 CRF 和 IOP 恢复时也观察到了类似的结果。
较高的 CRF 和注射前 IOP 与眼压升高独立相关。ORA 指标并不能极大地增强对注射后 IOP>50mmHg 患者的预测。较高的 CH 和 CRF 与玻璃体内注射后眼压恢复较快有关，这表明了眼生物力学特性与房水流出途径之间的动态关系。
