Miao Jing-Peng, Zeng Yi-Yun, Gu Xin-Ming, Zhang Xin-Yuan
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Key Laboratory of Institute of Ophthalmology and Visual Sciences, Beijing 100730, China.
Int J Ophthalmol. 2024 Nov 18;17(11):2052-2059. doi: 10.18240/ijo.2024.11.11. eCollection 2024.
To investigate the patterns of short-term intraocular pressure (IOP) fluctuations and identify the contributing factors following intravitreal injection in patients with retinal vascular diseases.
Totally 81 patients were enrolled in this case control study. Eyes were categorized into 7 groups, including age-related macular degeneration (AMD), polypoidal choroidal vasculopathy (PCV), idiopathic choroidal neovascularization (CNV), proliferative diabetic retinopathy (PDR), diabetic macular edema (DME), macular edema secondary to branch (BVOME) and central (CVOME) retinal vein occlusion. IOP was measured in all patients using rebound tonometer at 7 preset time points perioperatively. Additionally, based on the administered medication, the eyes were classified into three treatment groups, including dexamethasone intravitreal implant (IVO), intravitreal conbercept (IVC), and intravitreal ranibizumab (IVR). To compare IOP values at various time points across groups, we employed one-way ANOVA, independent sample -test or test and multivariate logistic regression analysis.
Peak IOP values across all groups were observed at 40s, and 5min after intravitreal injection. Statistical differences in IOP were detected at the 5min among the 7 indication groups (=2.50, =0.029). When examing the impact of medications, the IVO group exhibited lower average IOP values at both 40s and 5min compared to the IVC and IVR groups (<0.001; =0.007). The IOP values at 40s and 5min were significantly higher in BVOME and CVOME group compared to non-retinal vein occlusion-secondary macular edema (RVOME) group (<0.001). Multivariate logistic regression analysis further confirmed that IOP measurement at 40s was significantly higher in CVOME group than in non-RVOME group (OR=1.64, 95%CI: 1.09-2.47; =0.018).
Needle size plays a crucial role in the transient changes of IOP following intravitreal injection. Before administering intravitreal injection to patients with central retinal vein occlusion, it is essential to exclude any underlysing causes of increased IOP.
研究视网膜血管疾病患者玻璃体内注射后短期眼压（IOP）波动模式，并确定相关影响因素。
本病例对照研究共纳入81例患者。将眼睛分为7组，包括年龄相关性黄斑变性（AMD）、息肉状脉络膜血管病变（PCV）、特发性脉络膜新生血管（CNV）、增殖性糖尿病视网膜病变（PDR）、糖尿病性黄斑水肿（DME）、分支视网膜静脉阻塞继发黄斑水肿（BVOME）和中心视网膜静脉阻塞继发黄斑水肿（CVOME）。所有患者在围手术期的7个预设时间点使用回弹眼压计测量眼压。此外，根据所使用的药物，将眼睛分为三个治疗组，包括地塞米松玻璃体内植入物（IVO）、玻璃体内康柏西普（IVC）和玻璃体内雷珠单抗（IVR）。为比较各组在不同时间点的眼压值，我们采用单因素方差分析、独立样本t检验或检验以及多因素逻辑回归分析。
所有组的眼压峰值均在玻璃体内注射后40秒和5分钟时出现。7个适应证组在5分钟时眼压存在统计学差异（F = 2.50，P = 0.029）。在考察药物影响时，IVO组在40秒和5分钟时的平均眼压值均低于IVC组和IVR组（P < 0.001；P = 0.007）。与非视网膜静脉阻塞继发黄斑水肿（RVOME）组相比，BVOME组和CVOME组在40秒和5分钟时的眼压值显著更高（P < 0.001）。多因素逻辑回归分析进一步证实，CVOME组在40秒时的眼压测量值显著高于非RVOME组（OR = 1.64，95%CI：1.09 - 2.47；P = 0.018）。
针头大小在玻璃体内注射后眼压的短暂变化中起关键作用。在对中心视网膜静脉阻塞患者进行玻璃体内注射前，排除任何眼压升高的潜在原因至关重要。
