Vilares-Morgado Rodrigo, Correia Vera, Ferreira Ana Margarida, Alves Flávio, Melo António Benevides, Estrela-Silva Sérgio, Araújo Joana, Tavares-Ferreira João, Silva Marta, Rocha-Sousa Amândio, Carneiro Angela, Barbosa-Breda João
Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal.
UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.
Clin Ophthalmol. 2023 Nov 22;17:3613-3627. doi: 10.2147/OPTH.S441500. eCollection 2023.
To evaluate whether repeated intravitreal injections (IVI) with an anti-vascular endothelial growth factor (anti-VEGF) agent are associated with glaucomatous progression in eyes with glaucoma spectrum diseases (GSD).
Single-center, retrospective, longitudinal study of patients with bilateral and similar GSD who: (1) received ≥8 IVI in only one eye during the study period; (2) had ≥2 retinal nerve fiber layer thickness (RNFL) measurements obtained by spectral-domain optical coherence tomography (SD-OCT) at least 12 months apart. The primary outcome was the absolute RNFL thickness change, comparing injected and fellow uninjected eyes. Linear mixed effects models were constructed, including a multivariable model.
Sixty-eight eyes from 34 patients were included, 34 injected and 34 fellow uninjected eyes. Average baseline age was 67.68±21.77 years with a follow-up of 3.66±1.89 years and 25.12±14.49 IVI. RNFL thickness decreased significantly from 80.92±15.78 to 77.20±17.35 μm (<0.001; -1.18±1.93 μm/year) in injected eyes and from 79.95±17.91 to 76.61±17.97 μm (<0.001; -1.07±0.98 μm/year) in uninjected eyes. In a multivariable linear mixed model of injected eyes, only higher baseline RNFL thickness (p < 0.001) significantly predicted higher absolute RNFL thickness loss. Neither absolute RNFL thickness variation (=0.716) nor RNFL rate (=0.779) was significantly different between paired injected and uninjected eyes. Absolute IOP variation was not significantly different between groups (16.62±4.77 to 15.09±4.34 mmHg in injected eyes and 17.68±5.01 to 14.50±3.39 mmHg in fellow uninjected eyes; =0.248). The proportion of eyes receiving glaucoma medical treatment increased significantly in both groups (55.9% to 76.5% in injected eyes; =0.039; 58.8% to 76.5% in uninjected eyes; p = 0.031). The number of glaucoma medications also increased significantly in both groups (1.03±1.11 to 1.59±1.18 glaucoma medications in injected eyes; =0.003; 1.09±1.11 to 1.56±1.19 glaucoma medications in uninjected eyes; =0.003).
Repeated IVI do not seem to accelerate glaucomatous progression. Future studies with a longer follow-up are needed.
评估在患有青光眼谱系疾病（GSD）的眼中，反复玻璃体内注射（IVI）抗血管内皮生长因子（anti-VEGF）药物是否与青光眼进展相关。
对患有双侧且相似GSD的患者进行单中心、回顾性纵向研究，这些患者：（1）在研究期间仅一只眼接受了≥8次IVI；（2）通过光谱域光学相干断层扫描（SD-OCT）至少相隔12个月进行了≥2次视网膜神经纤维层厚度（RNFL）测量。主要结局是比较注射眼和未注射的对侧眼的绝对RNFL厚度变化。构建了线性混合效应模型，包括多变量模型。
纳入了34例患者的68只眼，34只注射眼和34只未注射的对侧眼。平均基线年龄为67.68±21.77岁，随访3.66±1.89年，平均进行了25.12±14.49次IVI。注射眼的RNFL厚度从80.92±15.78μm显著降至77.20±17.35μm（<0.001；-1.18±1.93μm/年），未注射眼从79.95±17.91μm降至76.61±17.97μm（<0.001；-1.07±0.98μm/年）。在注射眼的多变量线性混合模型中，仅较高的基线RNFL厚度（p<0.001）显著预测了较高的绝对RNFL厚度损失。配对的注射眼和未注射眼之间的绝对RNFL厚度变化（=0.716）和RNFL变化率（=0.779）均无显著差异。两组间绝对眼压变化无显著差异（注射眼从16.62±4.77mmHg降至15.09±4.34mmHg，未注射的对侧眼从17.68±5.01mmHg降至14.50±3.39mmHg；=0.248）。两组中接受青光眼药物治疗的眼的比例均显著增加（注射眼从55.9%增至76.5%；=0.039；未注射眼从58.8%增至76.5%；p = 0.031）。两组中青光眼药物的数量也均显著增加（注射眼从1.03±1.11种青光眼药物增至1.59±1.18种；=0.003；未注射眼从1.09±1.11种青光眼药物增至1.56±1.19种；=0.003）。
反复IVI似乎不会加速青光眼进展。需要进行更长随访期的未来研究。
