湿性年龄相关性黄斑变性患者注射雷珠单抗后早期眼压的变化

目的 观察湿性年龄相关性黄斑变性(wet age-related macular degenaration,wAMD）患者玻璃体腔注射雷珠单抗后早期眼压的变化。设计 前瞻性病例系列。研究对象 在北京医院接受玻璃体腔雷珠单抗（0.5mg/0.05ml）注射的wAMD患者135例（135眼）。方法 患者接受玻璃体腔注射雷珠单抗术前、术后10、30 min、2 h及术后1天，使用Topcon非接触眼压计分别测量眼压。观察患者注射后早期的眼压变化情况。主要指标 眼压。结果 患者术前眼压平均为（15.41±2.69） mmHg，术后10、30 min、2 h及术后1天的眼压平均值分别为（21.07±5.83） mmHg、（18.24±4.17） mmHg、（17.57±4.60） mmHg、（15.20±3.05） mmHg。术后2小时内的眼压与术前比有显著性差异（P均<0.05），而术后1天眼压与术前比无显著性差异（P=0.239）。术后各时间段眼压升高比率呈逐渐下降趋势，其中术后10 min，眼压升高比率（眼压升高比率≥10 mmHg占17.78%；≥15 mmHg占5.19%）及升高绝对值（眼压≥21 mmHg占45.93%；≥25 mmHg占21.48 %；≥30 mmHg占8.15%）均明显高于其他时间段。术前眼压越高，术后10 min眼压≥21 mmHg的比例越高（P=0.000, OR=0.117, 95%CI=0.051-0.268）。结论 大部分湿性年龄相关性黄斑变性患者玻璃体腔注射雷珠单抗后早期眼压显著升高，2小时内眼压变化明显；术前眼压偏高可能是玻璃体腔注射雷珠单抗早期眼压升高的危险因素。

Short-term effect of intravitreal injection Ranibizumab on intraocular pressure in wet age-related macular degeneration pa-tients

Objective To observe the short-term effect of intravitreal injection Ranibizumab （Lucentis） on intraocular pressure （IOP）. Design Prospective case series. Paticipants 135 eyes from 135 patients （70.54±8.69 y） with wet age-related macular degeneration treated with Ranibizumab in Beijing Hospital. Methods The IOP were measured by non-contact tonometer before injection, and at 10, 30,120 minutes and 1 day after injection in a sitting position. Main Outcome Measures The IOP pre and post-injection. Results Mean IOP was （15.41±2.69）mmHg, （21.07±5.83） mmHg, （18.24±4.17）mmHg, （17.57±4.60）mmHg, （15.20±3.05）mmHg, respectively, for the time points immediately before, 10, 30, 120 minutes, and 1 day after injection. Differences of lOP between before and after injec- tion were statistically significant at 10, 30, 120 minutes （all P〈0.05） except 1 day （P=0.239）; The ratio of increasing IOP gradually de- creased after injection, and the ratio at 10 minutes was significantly higher than other times （the ratio of IOP≥21 mmHg was 45.93%, I〉25 mmHg was 21.48%, t〉30 mmHg was 8.15%; the ratio of IOP increasing 10 mmHg was 17.78%, increasing 15 mmHg was 5.19%）. The higher the baseline IOP was the more patients with abnormal IOP postinjection occured （P=0.000, OR=0.117, 95%CI： 0.051-0.268）. Conclusion Intravitreal injection Ranibizumab （Lucentis） causes a considerable short-term transient rise on IOP in most of wet age-related macular degeneration patients. The IOP increase can be statistically significant from 10 minutes to 2 hours after injection. The high baseline IOP may be a risk factor for short-term rise on IOP postinjection.