Short-term Intraocular Pressure Changes Immediately After Intravitreal Injections of Anti-Vascular Endothelial Growth Factor Agents
Short-term Intraocular Pressure Changes Immediately After Intravitreal Injections of Anti-Vascular Endothelial Growth Factor Agents
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DOI：
10.1016/j.ajo.2008.07.007
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发表时间：
2008-12-01
影响因子：
4.2
通讯作者：
Covert, Douglas.
中科院分区：
文献类型：
--
作者：
Kim, Judy E.;Mantravadi, Anand V.;Covert, Douglas.
目的：评估玻璃体内注射雷尼单抗、贝伐单抗、佩加他尼和曲安奈德后立即监测眼压（IOP）变化的短期趋势和必要性。设计：回顾性、干预性病例系列。方法：回顾112例患者120眼213次连续注射的病历。在注射前、注射后以及每隔5分钟测量一次眼压，直到IOP低于30 mm Hg。通过手部运动视力测试和间接检眼镜检查来评估视神经灌注。对注射后IOP进行Kaplan-Meier和卡方分析，并对IOP尖峰与药物、针孔大小、注射量和青光眼病史的相关性进行分析。结果：注射前平均眼压为14 mm Hg（范围7 ~ 22 mm Hg）。平均眼压为44毫米汞柱（范围4至87毫米汞柱）。除了一只眼睛外，所有的眼睛都至少有手部运动视觉和右眼视神经灌注。96%的注射15分钟后IOP降至30 mm Hg以下，100%的注射30分钟后IOP降至30 mm Hg以下。有青光眼病史的眼睛眼压恢复正常所需时间较长（P = 0.002）。有青光眼病史的眼内眼压峰值在针眼孔径较小的眼内（P < 0.0001）和有青光眼病史的眼内（P = 0.001）具有统计学意义。结论：玻璃体内注射后IOP立即升高是常见的，但是短暂的。在大多数情况下，如果手部运动视力、视神经灌注和无眼内并发症得到证实，则无需在注射当天长时间监测IOP。但是，在某些情况下应考虑谨慎监测。[J]中华眼科杂志，2008;14:930-934。(C)爱思唯尔公司2008年版权所有。)
PURPOSE: To assess short-term trends and the need to monitor intraocular pressure (IOP) changes immediately after intravitreal injections of ranibizumab, bevacizumab, pegaptanib, and triamcinolone acetonide.DESIGN: Retrospective, interventional case series.METHODS: Charts of 213 consecutive injections to 120 eyes of 112 patients were reviewed. Pressures were measured before injection, immediately after injection (TO), and at five-minute intervals until IOP was less than 30 mm Hg. Optic nerve perfusion was assessed by testing for hand movement vision and by indirect ophthalmoscopic examination. Kaplan-Meier and Chi-square analyses of IOP after injections and correlation of IOP spikes to drug, needle bore size, injection volume, and history of glaucoma were performed.RESULTS: Mean preinjection IOP was 14 mm Hg (range, 7 to 22 mm Hg). Mean IOP at TO was 44 mm Hg (range, 4 to 87 mm Hg). All but one eye had at least hand movement vision and a perfused optic nerve at TO. IOP was reduced to less than 30 mm Hg in 96% of injections by 15 minutes and in 100% by 30 minutes. Eyes with a history of glaucoma took longer to normalize the IOP (P = .002). Statistically significant IOP spikes were observed with a smaller needle bore size (P < .0001) and in eyes with a history of glaucoma (P = .001).CONCLUSIONS: Elevations in IOP immediately after intravitreal injections are common, but are transient. Prolonged monitoring of IOP may not be necessary on the day of injection in most cases if hand movement vision, optic nerve perfusion, and lack of intraocular complications have been verified. However, cautious monitoring should be considered in select cases. (Am J Ophthalmol 2008; 146: 930-934. (C) 2008 by Elsevier Inc. All rights reserved.)