LoBue Stephen A, Gindina Sofya, Saba Nicholas J, Chang Tom, Davis Michael J, Fish Steven
Department of Ophthalmology, Acuity Eye Group, Pasadena, CA, USA.
Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
Clin Ophthalmol. 2023 Jun 13;17:1683-1690. doi: 10.2147/OPTH.S414212. eCollection 2023.
To study the effects of intravitreal injection (IVI) of anti-VEGF (vascular endothelial growth factor) agents on intraocular pressure (IOP) and find associations with acute pressure spikes.
This was a three-month, prospective study of patients receiving outpatient IVI of anti-VEGF agents for diabetic retinopathy (DR), age-related macular degeneration (AMD), and retinal vein occlusion (RVO) at the Acuity Eye Group Medical Centers. IOP was measured pre- and post-injection at 10-minute intervals up to 50 minutes after injection with a handheld tonometer. Patients with an IOP greater than 35 mmHg at 30 minutes received an anterior chamber paracentesis (ACP), while patients below 35 mmHg were monitored without intervention.
A total of 617 patients (51% female, 49% male) received IVI for DR (n = 199), AMD (n = 355), and RVO (n = 63). ACP was performed in 17 patients. Average pre-injection IOP was 16 ± 4 compared to 24 ± 7 mmHg for the non-ACP vs ACP group, respectively (mean ± standard deviation), p < 0.0001. IOP returned to baseline in 98% of patients at 50 minutes. A diagnosis of glaucoma and glaucoma suspect was more prevalent in the ACP group compared to the non-ACP group, 82.3% vs 14.2% and 17.6% vs 9.0%, respectively, p < 0.0001 and p > 0.05. Patients with a pre-injection IOP >25 mmHg and a history of glaucoma had a 58.3% rate of ACP. A 31-gauge needle had a higher mean increase in IOP from baseline compared to 30-gauge needle, p < 0.0001.
IOP spikes are most significant in the first 10 minutes after IVI but typically resolve within the first hour. However, utilizing a smaller 31-gauge IVI in patients with a glaucoma history and pre-injection IOP >25 mmHg may be associated with significant IOP spikes lasting longer than 30 minutes.
研究玻璃体内注射（IVI）抗血管内皮生长因子（VEGF）药物对眼压（IOP）的影响，并找出与急性眼压升高的关联。
这是一项为期三个月的前瞻性研究，研究对象为在视力眼科集团医疗中心接受门诊抗VEGF药物玻璃体内注射治疗糖尿病性视网膜病变（DR）、年龄相关性黄斑变性（AMD）和视网膜静脉阻塞（RVO）的患者。在注射后50分钟内，每隔10分钟用手持眼压计测量注射前后的眼压。注射后30分钟眼压大于35 mmHg的患者接受前房穿刺术（ACP），眼压低于35 mmHg的患者则不进行干预，直接监测。
共有617例患者（51%为女性，49%为男性）接受了抗VEGF药物玻璃体内注射治疗，其中DR患者199例，AMD患者355例，RVO患者63例。17例患者接受了前房穿刺术。非前房穿刺术组与前房穿刺术组的平均注射前眼压分别为16±4 mmHg和24±7 mmHg（均值±标准差），p<0.0001。98%的患者在50分钟时眼压恢复到基线水平。与非前房穿刺术组相比，前房穿刺术组中青光眼和青光眼可疑患者的诊断更为普遍，分别为82.3%对14.2%和17.6%对9.0%，p<0.0001和p>0.05。注射前眼压>25 mmHg且有青光眼病史的患者前房穿刺术发生率为58.3%。与30号针头相比，31号针头的眼压从基线水平的平均升高幅度更大，p<0.0001。
眼压升高在玻璃体内注射后最初10分钟最为显著，但通常在第一小时内消退。然而，对于有青光眼病史且注射前眼压>25 mmHg的患者，使用较细的31号玻璃体内注射针头可能会导致显著的眼压升高，且持续时间超过30分钟。
