不同药物玻璃体内注射后短期眼压变化

Short-term intraocular pressure changes after intravitreal injection with different drugs

目的观察玻璃体内注射雷珠单抗、阿柏西普及地塞米松玻璃体植入物(傲迪适)3种不同药物后短期眼压变化。方法前瞻性非随机对照研究。纳入2020年4月至2020年12月宜昌爱尔眼科医院玻璃体内注药连续病例112例(132只眼)。患者年龄26~86(62.8±12.3)岁,分成3组。其中玻璃体内注射0.7 mg傲迪适者18例为傲迪适组,注射0.1 ml雷珠单抗者49例为雷珠单抗组,注射0.1 ml阿柏西普者45例(59只眼)为阿柏西普组。观察注射后各时间点的眼压。结果术前、术后即刻、术后30 min、1 h、2 h及1 d:傲迪适组眼压依次为(16.9±3.5)mmHg、(18.6±6.2)mmHg、(18.4±5.0)mmHg、(17.6±5.0)mmHg、(16.7±4.1)mmHg及(15.1±4.0)mmHg(1 mmHg=0.133 kPa),各时间点差异无统计学意义(F=2.64,P=0.060);雷珠单抗组眼压依次为(15.8±4.1)mmHg、(45.7±13.8)mmHg、(19.2±4.9)mmHg、(17.2±3.9)mmHg、(16.3±3.3)mmHg及(13.1±2.9)mmHg,各时间点差异有统计学意义(F=191.26,P<0.001);阿柏西普组眼压依次为(14.9±3.4)mmHg、(49.2±15.0)mmHg、(17.9±4.4)mmHg、(16.4±4.0)mmHg、(15.6±4.1)mmHg及(13.0±3.0)mmHg,各时间点差异有统计学意义(F=267.41,P<0.001)。结论玻璃体内注射0.1 ml雷珠单抗或阿柏西普可引起暂时性眼压升高,均可自行降至正常。0.7 mg傲迪适玻璃体内注射引起的暂时性眼压升高不明显,较安全可靠。

Objective To observe the short-term changes of intraocular pressure in patients with intravitreal injection of ranibizumab,aflibercept or dexamethasone intravitreal implant(Ozurdex).Methods This was a prospective nonrandomized control study.Total of 132 eyes of 112 consecutive cases of fundus diseases with intravitreal injection were included.The age of these patients were 26 to 86(62.8±12.3)years.They were divided into three groups.Among them,18 patients in the ozurdex group were given intravitreal injection with 0.7 mg ozurdex,49 patients in the ranibizumab with 0.1 ml ranibizumab and 45 patients in the aflibercept group with 0.1 ml aflibercept.The intraocular pressure was observed at each time point after the injection.Results In the ozurdex group,intraocular pressure was(16.9±3.5)mmHg,(18.6±6.2)mmHg,(18.4±5.0)mmHg,(17.6±5.0)mmHg,(16.7±4.1)mmHg and(15.1±4.0)mmHg(1mmHg=0.133 kPa)at before operation,immediately,30 min,1 hour,2 hours and 1 day after operation.There was no statistical significance at each time point(F=2.64,P=0.060).In the ranibizumab group,intraocular pressure was(15.8±4.1)mmHg,(45.7±13.8)mmHg,(19.2±4.9)mmHg,(17.2±3.9)mmHg,(16.3±3.3)mmHg and(13.1±2.9)mmHg,and there was statistical significance at each time point(F=191.26,P<0.001).In the aflibercept group,intraocular pressure was(14.9±3.4)mmHg,(49.2±15.0)mmHg,(17.9±4.4)mmHg,(16.4±4.0)mmHg,(15.6±4.1)mmHg and(13.0±3.0)mmHg,and there was statistical significance at each time point(F=267.41,P<0.001).Conclusion Although the intravitreal injection of 0.1 ml ranibizumab or aflibercept can cause temporary ocular hypertension,IOP can decrease to normal automatically.The temporary increase in intraocular pressure caused by 0.7 mg ozurdex intravitreal injection is not obvious,which is safe and reliable.