PURPOSE

To examine the risk, prevalence, and progression of glaucoma development in age-related macular degeneration (AMD) eyes receiving intravitreal anti–vascular endothelial growth factor (anti-VEGF) injections compared to controls.

DESIGN

Retrospective clinical cohort study.

METHODS

Retrospective review of eyes receiving intravitreal anti-VEGF injections from January 1, 2004, to December 31, 2013, for exudative AMD. Age- and sex-matched control groups of eyes included eyes with nonexudative AMD (NEAMD) and no AMD. Eyes with a diagnosis of glaucoma or glaucoma suspect were reviewed for injection details, type and date of glaucoma diagnosis, glaucoma treatments, standard automated perimetry (SAP), and spectral domain optical coherence tomography (SD-OCT). Qualitative progression was determined by indication of glaucoma progression in provider notes. Quantitative progression was assessed based on change in mean deviation (MD) on SAP, retinal nerve fiber layer thickness on SD-OCT, and intraocular pressure (IOP).

RESULTS

There were 707 eyes of 504 patients treated with anti-VEGF injections and 1008 eyes in the NEAMD and no-AMD cohorts. There was no difference in glaucoma or suspect prevalence at initial presentation between eyes treated with injections and NEAMD (6.9% vs 9.7%, P = .22) or no-AMD controls (vs 8.5%, P = .55). There was no difference in cumulative 5-year probability of new glaucoma diagnosis after anti-VEGF injections compared to NEAMD (1.9% vs 1.0%, P = .69) or no-AMD controls (vs 1.6%, P = .88). There was no difference in qualitative progression of glaucoma in the injection cohort vs NEAMD (P = .19) or no-AMD controls (P = .61). The rate of MD change in injection eyes was similar to NEAMD eyes (P = .74) but greater than no-AMD eyes (P = .02). Eyes receiving injections required more topical glaucoma medications compared with NEAMD (P = .03) and more glaucoma laser treatments compared with no-AMD controls (P = .009). Eyes receiving injections did not require more frequent incisional glaucoma surgery compared with NEAMD (21.0% vs 15.0%, P = .95) or no-AMD controls (vs 10.0%, P = .10).

CONCLUSION

Eyes treated with intravitreal anti-VEGF injections for exudative AMD did not have increased risk of developing glaucoma compared with controls. Of those with a glaucoma diagnosis, exudative AMD eyes receiving injections required a greater number of topical glaucoma medications compared with NEAMD eyes and had a greater rate of MD loss than no-AMD controls.

中文翻译：

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玻璃体内抗血管内皮生长因子注射治疗年龄相关性黄斑变性眼青光眼的风险、患病率和进展

目的

与对照组相比，在接受玻璃体内抗血管内皮生长因子（抗 VEGF）注射的年龄相关性黄斑变性 (AMD) 眼中检查青光眼发展的风险、患病率和进展。

设计

回顾性临床队列研究。

方法

对 2004 年 1 月 1 日至 2013 年 12 月 31 日期间接受玻璃体内抗 VEGF 注射治疗渗出性 AMD 的眼睛进行回顾性检查。年龄和性别匹配的对照组眼睛包括非渗出性 AMD (NEAMD) 和无 AMD 的眼睛。检查诊断为青光眼或疑似青光眼的眼睛的注射细节、青光眼诊断的类型和日期、青光眼治疗、标准自动视野计 (SAP) 和光谱域光学相干断层扫描 (SD-OCT)。定性进展由提供者笔记中青光眼进展的指示确定。根据 SAP 的平均偏差 (MD)、SD-OCT 的视网膜神经纤维层厚度和眼压 (IOP) 的变化评估定量进展。

结果

504 名接受抗 VEGF 注射治疗的患者中有 707 只眼，NEAMD 和无 AMD 队列中有 1008 只眼。接受注射治疗的眼睛与接受 NEAMD 治疗的眼睛（6.9% 对 9.7%， P  = .22）或无 AMD 对照（对 8.5%，P  = .55）相比，初次就诊时青光眼或疑似患病率没有差异。与 NEAMD（1.9% 对 1.0%， P  = .69）或无 AMD 对照（对 1.6%，P  = .88）相比，抗 VEGF 注射后新诊断青光眼的累积 5 年概率没有差异。与 NEAMD ( P  = .19) 或无 AMD 对照 ( P =.61）。注射眼的 MD 变化率与 NEAMD 眼相似 ( P  = .74)，但大于无 AMD 眼 ( P  = .02)。与 NEAMD 相比，接受注射的眼睛需要更多的局部青光眼药物治疗 ( P  = .03)，与无 AMD 对照相比需要更多的青光眼激光治疗 ( P  = .009)。与 NEAMD（21.0% 对 15.0%， P  = .95）或无 AMD 对照（对 10.0%，P  = .10）相比，接受注射的眼睛不需要更频繁的青光眼切口手术。

结论

与对照组相比，用玻璃体内抗 VEGF 注射治疗渗出性 AMD 的眼睛患青光眼的风险没有增加。在诊断为青光眼的患者中，与 NEAMD 眼相比，接受注射的渗出性 AMD 眼需要更多的局部青光眼药物，并且 MD 损失率高于无 AMD 对照。