多次玻璃体腔注射抗血管内皮生长药物对黄斑水肿患者角膜生物力学的作用

Effects of repeated intravitreal injections of anti-VEGF drugs on corneal biomechanics in patients with macular edema

目的观察多次玻璃体腔注射抗血管内皮生长因子(VEGF)药物对角膜生物力学的作用。方法前瞻性病例对照研究。选取玻璃体腔注射抗VEGF治疗的患者共64例(64只眼),其中,湿性老年性黄斑变性(nAMD)19例(19只眼),糖尿病黄斑水肿(DME)20例(20只眼),视网膜静脉阻塞(RVO)黄斑水肿25例(25只眼)。阿柏西普(2 mg/0.05 ml)治疗29例(29只眼),雷株单抗(0.5 mg/0.05 ml)治疗35例(35只眼)。经过3次连续注射治疗的患者共64例(64只眼),经过4次连续注射治疗的患者共10例(10只眼)。使用眼反应分析仪(ORA)对角膜生物力学指标进行测量。比较每次注药后1个月与注射前的角膜阻力因子(CRF)、角膜滞后量(CH)、角膜补偿眼压值(IOPcc)、可重复的模拟Goldmann眼压值(IOPg)的变化。比较使用阿柏西普和雷株单抗两种不同药物多次玻璃体腔注射后以上所有指标的变化,同时比较nAMD、DME、RVO三种不同疾病多次玻璃体腔注射抗VEGF药物后以上所有指标的变化。结果(1)雷株单抗/阿柏西普多次注射后角膜生物力学各指标在术后各时间点较术前相比,差异无统计学意义;(2)注射次数与角膜生物力学各项指标的改变无明显相关性;(3)术前基线时,角膜生物力学等各指标在3种不同疾病患者基线时差异无统计学意义;(4)注射3次后,DME组的CH值较RVO组和AMD组升高,且差异有统计学意义。结论多次玻璃体腔注射抗VEGF药物使DME组的CH值则显著高于RVO组和AMD组。糖尿病黄斑水肿患者多次玻璃体腔注射抗VEGF药物对角膜生物力学会产生一定影响。

Objective To observe the effect of repeated intravitreal injections of anti-vascular endothelial growth factor(anti-VEGF)on corneal biomechanics.Methods A retrospective case series study.A total of 64 patients were treated with intravitreal injection of anti-VEGF.There were 19 cases of neovascularage-related macular degeneration(nAMD),20 cases of diabetic macular edema(DME)and 25 cases of retinal vein occlusion(RVO).29 cases were treated with Aflibercept(2 mg/0.05 ml)and 35 cases withRanibizumab(0.5 mg/0.05 ml).A total of 64 patients were treated with three consecutive in⁃jections,10 patients were treated with four consecutive injections.Corneal resistance factor(CRF),corneal hysteresis(CH),corneal compensation intraocular pressure(IOPcc),reproducible simulated goldmann intraocular pressure(IOPg)were collected.The changes of all the above indexes were compared after multiple intravitreal injections of two different drugs(Ranibizumab,Aflibercept)and in three different diseases(nAMD,DME,RVO).Results(1)There was no significant difference in corneal biomechanics at each time point after surgery of Ranibizumab or Aflibercept.(2)The number of injections had no significant correlation with the changes of corneal biomechanics.(3)There were no significant differences in corneal biomechanics at baseline among patients with three different diseases.(4)After 3 injections,the CH in DME group was higher than that in RVO and nAMD groups,and with significant differences.Conclusions The CH of DME group was significantly higher than that of RVO group and nAMD group after multiple intravitreal injections of anti-VEGF drugs.In patients with DME,multiple intravitreal injections of anti-VEGF drugs have effects on corneal biomechanics.