中华眼底病杂志

中华眼底病杂志

玻璃体腔注射雷珠单抗后患眼短期眼压升高的影响因素分析

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目的 观察分析影响玻璃体腔注射雷珠单抗后患眼短期眼压升高的相关因素。 方法 临床前瞻性观察性研究。临床检查确诊为适合玻璃体腔注射雷珠单抗治疗的视网膜病变患者292例292只眼纳入研究。其中,男性157例,女性135例;老年性黄斑变性(AMD)193例,非AMD99例。平均年龄(62.75±13.74)岁。平均最小分辨角对数最佳矫正视力(BCVA)为0.68±0.47;平均眼压为18.1 mmHg(1 mmHg=0.133 kPa)。所有患眼接受玻璃体腔注射雷珠单抗0.05 ml(含雷珠单抗0.5 mg)治疗。注射后10、30 min及2 h、1 d采用非接触气动式眼压计分别行坐位眼压测量。将注射后10 min眼压升高10 mmHg及以上定义为眼压升高,眼压升高小于10 mmHg为眼压稳定,并以此分组。对比两组患眼各项资料差异,采用多变量logistic回归分析法分析影响玻璃体腔注射雷珠单抗后患眼眼压升高的相关因素。 结果 注射后10、30 min及2 h、1 d,患眼平均眼压为23.8、20.5、19.9、17.4 mmHg。注射后10、30 min及2 h时眼压较注射前平均升高5.8、2.4、1.8 mmHg,注射后1 d时眼压较注射前平均降低0.7 mmHg。292例292只眼中,眼压升高组68例68只眼,眼压稳定组224例224只眼。两组患者年龄(Z=−0.732)、性别(χ2=1.929)、眼别(χ2=2.910)、BCVA(Z=−0.039)、疾病类型(χ2=2.088)比较,差异无统计学意义(P>0.05);注药次数(Z=−2.413,P=0.001)、注射前眼压(Z=−3.405,P=0.016)以及注射后各时间的眼压(Z=−11.501、−8.366、−5.135、−3.568,P<0.01)比较,差异均有统计学意义(P<0.05)。多变量logistic回归分析结果显示,基础眼压与注射后10 min眼压升高呈正相关(B=−0.844,比值比=0.43,95%可信区间0.24~0.76,P=0.004)。患眼基础眼压越高玻璃体腔注射雷珠单抗后眼压升高的可能性越大。 结论 影响玻璃体腔注射雷珠单抗后患眼短期眼压升高的相关因素主要是基础眼压水平;基础眼压越高,眼压升高风险越高。

Objective To investigate the factors associated with short-term elevation of intraocular pressure after ranibizumab intravitreal injection. Methods 292 eyes of 292 patients who were diagnosed retinopathy and suitable to receive ranibizumab intravitreal injection were enrolled in this prospective clinical study. There were 157 males and 135 females. 193 patients diagnosed with age-related macular degeneration and 99 other retinopathy patients. Mean age of patients was 62.75±13.74 years. All subjects underwent systemic and comprehensive ophthalmology examinations. The mean BCVA was 0.68±0.47 logMAR. Mean basal intraocular pressure was 18.1 mmHg (1 mmHg=0.133 kPa). All patients received intravitreal injection with 0.05 ml of ranibizumab (0.5 mg). The intraocular pressure were measured by non-contact tonometer at 10, 30, 120 minutes and 1 day after injection in a sitting position. The patients were grouped by the changes of intraocular pressure 10 minutes after injection. The elevation was more than 10 mmHg as elevation group and less than 10 mmHg as stable group. Analyze the possible related factors with elevation of intraocular pressure after ranibizumab intravitreal injection by comparing the different datum of two groups. Results The mean intraocular pressure were 23.8, 20.5, 19.9 and 17.4 mmHg at 10, 30, 120 minutes and 1 day after injection. The significant elevation level were 5.8, 2.4, 1.8, −0.7 mmHg compared with basal intraocular pressure. Among 292 eyes, intraocular pressure elevation in 68 eyes and stabled in 224 eyes. The age (Z=−0.732), gender (χ2=1.929), right or left eye (χ2=2.910), BCVA (Z=−0.039), diseases (χ2=2.088) were no significant difference between two groups (P>0.05). The injection number (Z=−2.413, P=0.001), basal intraocular pressure (Z=−3.405, P=0.016) and elevations after injection (Z=−11.501, −8.366, −5.135, −3.568; P<0.01) were significantly different comparing two groups (P<0.05). By logistic regression analysis, basal intraocular pressure was positively correlated with the elevation of intraocular pressure 10 minutes after injection (B=−0.844, OR=0.43, 95%CI 0.24−0.76, P=0.004). Patients with higher basal intraocular pressure may occur intraocular pressure elevation after ranibizumab intravitreal injection much probably. Conclusions The factors associated with short-term elevation of intraocular pressure after ranibizumab intravitreal injection were basal intraocular pressure. The higher basal intraocular pressure, the higher risk to gain elevation of intraocular pressure after injection.

关键词: 抗体,单克隆; 血管生成抑制剂/治疗应用; 高眼压; 影响因素分析

Key words: Angiogenesis inhibitors/therapeutic use; Antibodies, monoclonal; Ocular Hypertension; Root cause analysis

引用本文: 宋爽, 张鹏, 谷潇雅, 卢颖毅, 喻晓兵, 戴虹. 玻璃体腔注射雷珠单抗后患眼短期眼压升高的影响因素分析. 中华眼底病杂志, 2018, 34(5): 432-435. doi: 10.3760/cma.j.issn.1005-1015.2018.05.004 复制

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