Association of Repeated Intravitreous Bevacizumab Injections With Risk for Glaucoma Surgery
Association of Repeated Intravitreous Bevacizumab Injections With Risk for Glaucoma Surgery
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DOI：
10.1001/jamaophthalmol.2017.0059
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发表时间：
2017-04-01
影响因子：
8.1
通讯作者：
Mikelberg, Frederick S.
中科院分区：
文献类型：
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作者：
Eadie, Brennan D.;Etminan, Mahyar;Mikelberg, Frederick S.
重要性玻璃体内注射抗血管内皮生长因子（VEGF）药物与眼内压持续升高相关。这种持续升高的眼内压可能会导致青光眼手术，以降低这pressure. ObjectiveTo确定反复玻璃体内贝伐单抗injective.DESIGN，设置，PARTICIPANTS青光眼手术的风险这巢式，病例对照研究获得和分析的数据，从大型，人口为基础的，链接的健康数据库支持的不列颠哥伦比亚省卫生部在加拿大。研究参与者包括不列颠哥伦比亚省的所有眼科问题患者，例如省视网膜疾病治疗计划的患者，他们在2009年1月1日至2013年12月31日期间接受了玻璃体内贝伐单抗注射治疗渗出性年龄相关性黄斑变性。使用青光眼手术代码确定病例，包括小梁切除术、复杂性小梁切除术、青光眼引流装置和睫状体切除术。对于每种情况，确定10名对照，并在年龄、先前存在的青光眼、日历时间和随访时间方面进行匹配。在病例组和对照组中，每年接受玻璃体内贝伐珠单抗注射的次数为3次或更少，4 - 6次，7次或更多次。数据分析从2016年2月23日至2016年11月14日进行。主要结局和指标：病例组和对照组中青光眼手术风险与每年玻璃体内贝伐单抗注射次数的比较。率比调整协变量（糖尿病，心肌梗死，中风，和维替泊芬的使用）。结果74例青光眼手术和740名对照被确定，平均（SD）年龄为81.3（8.4）岁的情况下，81.4（7.9）岁的对照。病例组的男性多于对照组（38例[51.4%] vs 272例[36.8%]）。在每年接受7次或7次以上注射的患者中，青光眼手术的校正率比为2.48（95%CI，1.25-4.93）。与对照组相比，病例中7次或7次以上注射的次数高出10.3%。每年接受4至6次注射的人与接受3次或更少注射的人的调整率比为1.65%（95%CI，0.84-3.23）。结论和相关性从这个大，药物流行病学研究表明，每年玻璃体内注射贝伐单抗7次或更多次与青光眼手术的风险较高相关，在同一方向上无统计学显著性比率。
IMPORTANCE Intravitreous injections of anti-vascular endothelial growth factor (VEGF) agents are associated with a sustained increase in intraocular pressure. This sustained elevated intraocular pressure could lead to higher rates of glaucoma surgery to lower this pressure.OBJECTIVE To determine the risk of glaucoma surgery following repeated intravitreous bevacizumab injections.DESIGN, SETTING, PARTICIPANTS This nested, case-control study acquired and analyzed data from large, population-based, linked health databases supported by the British Columbia Ministry of Health in Canada. Study participants included all patients with ophthalmic issues in British Columbia, such as those of the Provincial Retinal Diseases Treatment Program, who had received intravitreous bevacizumab injections for exudative age-related macular degeneration between January 1, 2009, and December 31, 2013. Cases were identified using glaucoma surgical codes for trabeculectomy, complicated trabeculectomy, glaucoma drainage device, and cycloablative procedure. For each case, 10 controls were identified and matched for age, preexisting glaucoma, calendar time, and follow-up time. The number of intravitreous bevacizumab injections received per year-3 or fewer, 4 to 6, or 7 or more-was determined for both cases and controls. Data analysis was performed from February 23, 2016, to November 14, 2016.MAIN OUTCOMES AND MEASURES Risk of glaucoma surgery compared with the number of intravitreous bevacizumab injections per year in cases and controls. Rate ratios were adjusted for covariates (diabetes mellitus, myocardial infarction, stroke, and verteporfin use).RESULTS Seventy-four cases of glaucoma surgery and 740 controls were identified, with a mean (SD) age of 81.3 (8.4) years for cases and 81.4 (7.9) for controls. The case group had more males than the control group (38 [51.4%] vs 272 [36.8%]). The adjusted rate ratio of glaucoma surgery among those who received 7 or more injections per year was 2.48 (95% CI, 1.25-4.93). There was a 10.3% higher number of 7 or more injections among cases compared with controls. The adjusted rate ratio for those who received 4 to 6 injections per year compared with those who received 3 or fewer was 1.65%(95% CI, 0.84-3.23).CONCLUSIONS AND RELEVANCE Findings from this large, pharmacoepidemiologic study suggest that 7 or more intravitreous injections of bevacizumab annually is associated with a higher risk of glaucoma surgery and that 4 to 6 injections per year show a nonstatistically significant rate ratio in the same direction.