连续玻璃体内注射与干眼的相关性。

Associations between Serial Intravitreal Injections and Dry Eye.

机构信息

Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway; Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.

出版信息

Ophthalmology. 2023 May;130(5):509-515. doi: 10.1016/j.ophtha.2023.01.009. Epub 2023 Jan 21.

DOI:10.1016/j.ophtha.2023.01.009

PMID:36693594

Abstract

PURPOSE

To investigate the effects of serial intravitreal injections (IVIs) on the ocular surface and meibomian glands (MGs) in patients treated with anti-vascular endothelial growth factor (anti-VEGF) for neovascular age-related macular degeneration (nAMD).

DESIGN

Retrospective, controlled, observational study.

PARTICIPANTS

Patients with nAMD receiving unilateral IVIs with anti-VEGF agents. The fellow eye was used as control.

METHODS

Tear film and ocular surface examinations were performed on a single occasion at a minimum of 4 weeks after IVI. A pre-IVI asepsis protocol with povidone-iodine (PVP-I) was applied.

MAIN OUTCOME MEASURES

Upper and lower MG loss, tear meniscus height (TMH), bulbar redness (BR) score, noninvasive tear break-up time (NIBUT), tear film osmolarity (TOsm), Schirmer test, corneal staining, fluorescein tear film break-up time (TBUT), meibomian gland expressibility (ME), and meibum quality.

RESULTS

Ninety patients with a mean age of 77.5 years (standard deviation [SD], 8.4; range 54-95) were included. The median number of IVIs in treated eyes was 19.5 (range, 2-132). Mean MG loss in the upper eyelid was 19.1% (SD, 11.3) in treated eyes and 25.5% (SD, 14.6) in untreated fellow eyes (P = 0.001). For the lower eyelid, median MG loss was 17.4% (interquartile range [IQR], 9.4-29.9) in treated eyes and 24.5% (IQR, 14.2-35.2) in fellow eyes (P < 0.001). Mean BR was 1.32 (SD, 0.46) in treated eyes versus 1.44 (SD, 0.45) in fellow eyes (P = 0.017). Median TMH was 0.36 mm (IQR, 0.28-0.52) in treated eyes and 0.32 mm (IQR, 0.24-0.49) in fellow eyes (P = 0.02). There were no differences between treated and fellow eyes regarding NIBUT, TOsm, Schirmer test, corneal staining, fluorescein TBUT, ME, or meibum quality.

CONCLUSIONS

Repeated IVIs with anti-VEGF with preoperative PVP-I application was associated with reduced MG loss, increased tear volume, and reduced signs of inflammation compared with fellow nontreated eyes in patients with nAMD. This regimen may thus have a beneficial effect on the ocular surface.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

摘要

目的

研究抗血管内皮生长因子（anti-VEGF）治疗新生血管性年龄相关性黄斑变性（nAMD）患者时，连续玻璃体内注射（IVI）对眼表和睑板腺（MGs）的影响。

设计

回顾性、对照、观察性研究。

参与者

接受单侧 IVI 联合抗 VEGF 药物治疗 nAMD 的患者。对侧眼作为对照。

方法

在 IVI 后至少 4 周的一次就诊时进行泪膜和眼表检查。应用聚维酮碘（PVP-I）进行术前无菌处理方案。

主要观察指标

上、下 MG 缺失、泪膜新月高度（TMH）、球结膜充血（BR）评分、非侵入性泪膜破裂时间（NIBUT）、泪膜渗透压（TOsm）、Schirmer 试验、角膜染色、荧光素泪膜破裂时间（TBUT）、MG 分泌能力（ME）和睑脂质量。

结果

纳入 90 例平均年龄 77.5 岁（标准差 [SD]，8.4；范围 54-95）的患者。治疗眼的中位数 IVI 次数为 19.5（范围，2-132）。治疗眼的上睑 MG 缺失率为 19.1%（SD，11.3），未治疗的对侧眼为 25.5%（SD，14.6）（P=0.001）。下睑 MG 缺失率，治疗眼为 17.4%（四分位距 [IQR]，9.4-29.9），对侧眼为 24.5%（IQR，14.2-35.2）（P<0.001）。治疗眼的 BR 平均为 1.32（SD，0.46），对侧眼为 1.44（SD，0.45）（P=0.017）。治疗眼的 TMH 中位数为 0.36 mm（IQR，0.28-0.52），对侧眼为 0.32 mm（IQR，0.24-0.49）（P=0.02）。治疗眼与对侧眼在 NIBUT、TOsm、Schirmer 试验、角膜染色、荧光素 TBUT、ME 或睑脂质量方面均无差异。