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The Effect of Anti-Vascular Endothelial Growth Factor Agents on Intraocular Pressure and Glaucoma: A Report by the American Academy of Ophthalmology.
Ophthalmology ( IF 13.1 ) Pub Date : 2018-11-22 , DOI: 10.1016/j.ophtha.2018.11.019
Ambika Hoguet 1 , Philip P Chen 2 , Anna K Junk 3 , Prithvi Mruthyunjaya 4 , Kouros Nouri-Mahdavi 5 , Sunita Radhakrishnan 6 , Hana L Takusagawa 7 , Teresa C Chen 8
Affiliation  

PURPOSE To assess the effect of intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents on immediate and long-term intraocular pressure (IOP) elevation and glaucoma. METHODS Literature searches of the PubMed and Cochrane databases, last conducted in April 2018, yielded 253 unique citations. Of these, 41 met the inclusion criteria and were rated according to the strength of evidence. Two articles were rated level I, 17 were rated level II, and 15 were rated level III; an additional 7 were excluded because of poor study design and lack of relevance to the topic under evaluation. RESULTS The studies that reported on short-term IOP elevation (i.e., between 0 and 60 minutes) showed that an immediate increase in IOP is seen in all patients when measured between 0 and 30 minutes of intravitreal injection and that the IOP elevation decreases over time. The data on long-term IOP elevation were mixed; 7 studies reported that between 4% and 15% of patients developed sustained elevation of IOP at 9 to 24 months after injection, whereas 6 studies found no long-term change in IOP from 1 to 36 months after injection. Pretreatment with glaucoma medications, anterior chamber tap, vitreous reflux, longer intervals between injections, and longer axial lengths were associated with lower IOP elevations after injection. Data were mixed on the relationship between IOP increase and the type of intravitreal injection, number of intravitreal injections, preexisting glaucoma, and globe decompression before injection. There were no data on the onset or progression of glaucoma in the studies reviewed in this assessment. CONCLUSIONS Intravitreal injection of anti-VEGF agents results in an immediate and transient increase in IOP. A long-term increase in IOP also may be seen, and further studies are needed to determine at-risk populations. Although there is some suggestion in the literature, there is currently insufficient data to determine the impact of intravitreal anti-VEGF injections on glaucoma progression. Although pretreatment with glaucoma medications, performing anterior chamber paracentesis, or increasing the interval between injections may reduce the impact of transient IOP elevation, the clinical significance and associated risks of these interventions are unknown.

中文翻译:

抗血管内皮生长因子药物对眼内压和青光眼的作用:美国眼科学会的一份报告。

目的评估玻璃体内注射抗血管内皮生长因子(VEGF)药物对即刻和长期眼内压(IOP)升高和青光眼的影响。方法最近一次于2018年4月对PubMed和Cochrane数据库进行的文献检索获得了253条独特的引文。其中有41个符合纳入标准,并根据证据强度进行了评级。I级有两件,II级有17件,III级有15件;由于不良的研究设计和与所评估主题的相关性,另外7个被排除在外。结果报道了短期IOP升高的研究(即,在0至60分钟之间)显示,当在玻璃体内注射0至30分钟之间测量时,所有患者的IOP立即升高,并且IOP升高随时间降低。长期眼压升高的数据好坏参半。7项研究报告说,注射后9至24个月,有4%至15%的患者出现IOP持续升高,而6项研究发现,注射后1至36个月,IOP没有长期变化。青光眼药物的预处理,前房分流,玻璃体反流,注射间隔时间更长和轴向长度更长,与注射后较低的IOP升高有关。关于IOP增加与玻璃体内注射类型,玻璃体内注射次数,既往青光眼,注射前进行地球仪减压。在该评估中,没有关于青光眼发作或进展的数据。结论玻璃体内注射抗VEGF药物可导致IOP立即和短暂增加。还可以看到IOP的长期增加,需要进一步的研究来确定高危人群。尽管文献中有一些建议,但目前尚无足够的数据来确定玻璃体内抗VEGF注射对青光眼进展的影响。尽管用青光眼药物进行预处理,进行前房穿刺或增加注射间隔可以减轻短暂性IOP升高的影响,但这些干预措施的临床意义和相关风险尚不清楚。在该评估中,没有关于青光眼发作或进展的数据。结论玻璃体内注射抗VEGF药物可导致IOP立即和短暂增加。还可以看到IOP的长期增加,需要进一步的研究来确定高危人群。尽管文献中有一些建议,但目前尚无足够的数据来确定玻璃体内抗VEGF注射对青光眼进展的影响。尽管用青光眼药物进行预处理,进行前房穿刺或增加注射间隔可以减轻短暂性IOP升高的影响,但这些干预措施的临床意义和相关风险尚不清楚。在该评估中,没有关于青光眼发作或进展的数据。结论玻璃体内注射抗VEGF药物可导致IOP立即和短暂增加。还可以看到IOP的长期增加,需要进一步的研究来确定高危人群。尽管文献中有一些建议,但目前尚无足够的数据来确定玻璃体内抗VEGF注射对青光眼进展的影响。尽管用青光眼药物进行预处理,进行前房穿刺或增加注射间隔可以减轻短暂性IOP升高的影响,但这些干预措施的临床意义和相关风险尚不清楚。结论玻璃体内注射抗VEGF药物可导致IOP立即和短暂增加。还可以看到IOP的长期增加,需要进一步的研究来确定高危人群。尽管文献中有一些建议,但目前尚无足够的数据来确定玻璃体内抗VEGF注射对青光眼进展的影响。尽管用青光眼药物进行预处理,进行前房穿刺或增加注射间隔可以减轻短暂性IOP升高的影响,但这些干预措施的临床意义和相关风险尚不清楚。结论玻璃体内注射抗VEGF药物可导致IOP立即和短暂增加。还可以看到IOP的长期增加,需要进一步的研究来确定高危人群。尽管文献中有一些建议,但目前尚无足够的数据来确定玻璃体内抗VEGF注射对青光眼进展的影响。尽管用青光眼药物进行预处理,进行前房穿刺或增加注射间隔可以减轻短暂性IOP升高的影响,但这些干预措施的临床意义和相关风险尚不清楚。尽管文献中有一些建议,但目前尚无足够的数据来确定玻璃体内抗VEGF注射对青光眼进展的影响。尽管用青光眼药物进行预处理,进行前房穿刺或增加注射间隔可以减轻短暂性IOP升高的影响,但这些干预措施的临床意义和相关风险尚不清楚。尽管文献中有一些建议,但目前尚无足够的数据确定玻璃体内抗VEGF注射对青光眼进展的影响。尽管用青光眼药物进行预处理,进行前房穿刺或增加注射间隔可以减轻短暂性IOP升高的影响,但这些干预措施的临床意义和相关风险尚不清楚。
更新日期:2018-11-22
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