Ramsey David J, McCullum James C, Steinberger Elise E, Zhang Yubo, Alwreikat Amer Mosa, Cooper Michael L, Roh Shiyoung, Cotran Paul R
Department of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA, USA.
Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA.
Eye (Lond). 2022 Sep;36(9):1813-1819. doi: 10.1038/s41433-021-01729-1. Epub 2021 Aug 12.
To understand intraocular pressure (IOP) response after switching from intravitreal bevacizumab (IVB) and/or ranibizumab (IVR) to intravitreal aflibercept (IVA) for treatment-resistant neovascular age-related macular degeneration (nAMD) in patients with and without coexisting glaucoma-related diagnoses.
Retrospective, cross-sectional comparative case series of 62 eyes of 58 patients treated with intravitreal injection for nAMD from March 2010 to April 2018. Patients with glaucoma-related diagnoses, defined here as open-angle glaucoma or suspicion of open-angle glaucoma, ocular hypertension, and/or narrow-angle glaucoma, were compared to those without glaucoma. IOP data were collected at baseline, at the three visits where patients received loading doses of IVB/IVR, and at all of the visits following the switch to IVA through the end of follow-up.
19 eyes with pre-existing glaucoma-related diagnoses were compared to 43 eyes without such diagnoses. Baseline IOP was similar for glaucoma and non-glaucoma patients. The loading doses of IVB/IVR did not impact IOP; however, a small, sustained rise in IOP was noted among patients with glaucoma-related diagnoses by the final IVB/IVR injections before the switch to IVA (∆IOP 1.61 ± 0.52 mmHg, P < 0.002). After conversion to IVA, pre-injection IOP declined in eyes both with (-1.59 ± 0.54 mmHg, P < 0.001) and without (-0.99 ± 0.28 mmHg, P < 0.001) glaucoma-related diagnoses.
IOP in patients with glaucoma-related diagnoses appears to be more sensitive to intravitreal injections than it is in patients without glaucoma-related diagnoses. It rises with IVB/IVR and declines after the switch to IVA. Switching patients with nAMD to IVA may present an opportunity to lower IOP in patients with glaucoma.
了解在患有和未患有青光眼相关诊断的患者中，对于治疗抵抗性新生血管性年龄相关性黄斑变性（nAMD），从玻璃体内注射贝伐单抗（IVB）和/或雷珠单抗（IVR）转换为玻璃体内注射阿柏西普（IVA）后的眼压（IOP）反应。
对2010年3月至2018年4月间接受玻璃体内注射治疗nAMD的58例患者的62只眼进行回顾性横断面比较病例系列研究。将患有青光眼相关诊断（在此定义为开角型青光眼或疑似开角型青光眼、高眼压症和/或闭角型青光眼）的患者与未患有青光眼的患者进行比较。在基线、患者接受IVB/IVR负荷剂量的三次就诊时以及转换为IVA后的所有就诊直至随访结束时收集IOP数据。
将19只患有既往青光眼相关诊断的眼与43只未患有此类诊断的眼进行比较。青光眼患者和非青光眼患者的基线IOP相似。IVB/IVR的负荷剂量对IOP没有影响；然而，在转换为IVA之前的最后一次IVB/IVR注射时，患有青光眼相关诊断的患者中观察到IOP有小幅持续升高（∆IOP 1.61±0.52 mmHg，P<0.002）。转换为IVA后，无论有无青光眼相关诊断，注射前的IOP均下降（有青光眼相关诊断的眼下降-1.59±0.54 mmHg，P<0.001；无青光眼相关诊断的眼下降-0.99±0.28 mmHg，P<0.001）。
患有青光眼相关诊断的患者的IOP似乎比未患有青光眼相关诊断的患者对玻璃体内注射更敏感。它在使用IVB/IVR时升高，在转换为IVA后下降。将nAMD患者转换为IVA可能为降低青光眼患者的IOP提供机会。
