Luqman Faizan, Bibi Hafsa, Mukhtar Marwa, Zafar Fahad, Ahmed Hafsa, Khizer Muhammad A, Gul Nazli
Ophthalmology, Khyber Medical College, Peshawar, PAK.
Ophthalmology, Medical Teaching Institution (MTI) Khyber Teaching Hospital, Peshawar, PAK.
Cureus. 2023 Sep 16;15(9):e45371. doi: 10.7759/cureus.45371. eCollection 2023 Sep.
The clinical use of intravitreal bevacizumab (IVB), a recombinant humanized monoclonal antibody that functions as an anti-vascular endothelial growth factor (anti-VEGF), has recently increased in patients with retinal ischemic diseases such as proliferative diabetic retinopathy (PDR). The short-term and long-term complications associated with this procedure have not been well established. We aimed to study the possible short-term complication of intraocular pressure (IOP) fluctuations shortly after IVB injection in patients with PDR.
A prospective case series of diabetic patients with PDR who underwent IVB injection was performed in the Department of Ophthalmology, Medical Teaching Institution, Khyber Teaching Hospital, Peshawar, Pakistan, from November 1, 2020, to May 1, 2021. The total number of PDR patients of both sexes included in the study was 101. A slit lamp examination was performed, and IOP readings were recorded before and 30 min after IVB injection using Goldmann applanation tonometry (GAT). IBM Statistical Package for the Social Sciences version 22 for Windows was used to analyze the data. Safety of the procedure, defined as IOP 20 mmHg 30 min after IVB injection, was determined and stratified according to sex, age, duration of diabetes, and baseline IOP. A post-stratification chi-square test was applied, and a p-value <0.05 was taken as statistically significant.
In this study, 60.4% of the participants were male and 39.6% were female. The age of the patients ranged from 30 to 75 years, with a mean age of 55.66±6.37 years. The mean duration of diabetes among the participants was 7.73±2.94 years and the mean baseline IOP was 15.40±1.77 mmHg. Safety (IOP 20 mmHg 30 min after IVB injection) was observed in 90.1% of the patients.
IVB injections are safe for use in patients with PDR in terms of immediate IOP changes. However, patients with higher baseline IOP (>15 mmHg) are more likely to develop increased IOP post-procedure and prophylaxis may be prudent in such cases.
玻璃体内注射贝伐单抗（IVB）是一种重组人源化单克隆抗体，具有抗血管内皮生长因子（抗VEGF）的作用，近年来在增殖性糖尿病视网膜病变（PDR）等视网膜缺血性疾病患者中的临床应用有所增加。与该操作相关的短期和长期并发症尚未完全明确。我们旨在研究PDR患者IVB注射后不久眼压（IOP）波动可能出现的短期并发症。
2020年11月1日至2021年5月1日，在巴基斯坦白沙瓦开伯尔教学医院医学教学机构眼科对接受IVB注射的PDR糖尿病患者进行了一项前瞻性病例系列研究。纳入研究的PDR患者共101例，男女皆有。进行了裂隙灯检查，并使用Goldmann压平眼压计（GAT）在IVB注射前和注射后30分钟记录眼压读数。使用适用于Windows的IBM社会科学统计软件包第22版分析数据。根据性别、年龄、糖尿病病程和基线眼压确定并分层分析该操作的安全性，定义为IVB注射后30分钟眼压≤20 mmHg。应用分层后卡方检验，p值<0.05被视为具有统计学意义。
本研究中，60.4%的参与者为男性，39.6%为女性。患者年龄在30至75岁之间，平均年龄为55.66±6.37岁。参与者的平均糖尿病病程为7.73±2.94年，平均基线眼压为15.40±1.77 mmHg。90.1%的患者观察到安全性（IVB注射后30分钟眼压≤20 mmHg）。
就即刻眼压变化而言，IVB注射用于PDR患者是安全的。然而，基线眼压较高（>15 mmHg）的患者术后眼压升高的可能性更大，在这种情况下进行预防可能是谨慎的。
