33 EyeWorld Asia Pacific | June 2024 2023年，美国食品药品监督管理局批准了最早的两种治疗地图样萎 缩（GA）的药物。Dr. Weng说，这些是补体抑制剂，可以每月或每隔 一个月进行玻璃体内注射。“由于这种频率，加上药物体积为0.1毫升 （典型注射量的两倍），要对可能出现的任何上市后不良反应保持警 惕，”她说。“Pegcetacoplan和Avacincaptadpegol的关键试验中报 告的眼压升高率在2%至9%之间，但被认为与注射手术有关，而不是 与药物本身有关，大多数是短暂的和自行缓解的。”19 Dr. Weng补充说，一些最近批准的和正在研究的药物的给药量比通 常注射的要大。“高剂量阿非利西普是标准阿非利西剂量的四倍，体 积为0.07毫升，”她说。“鉴于人们担心这些药物和其他药物可能会 对眼压产生影响，一些视网膜专科医生会在注射前向眼球施压，以 防止注射后的眼压峰值，尽管这样做的好处尚未得到证实。”她补充 道，随着对玻璃体内注射与青光眼之间关系的了解越来越多，视网 膜专科医生应该监测所有患者的眼压并与青光眼同事密切合作。 Dr. Schehlein说，玻璃体内注射后对眼压的影响分为两个阶段。首 先是注入眼睛的额外液体产生的初始IOP峰值，这通常是短暂的会 消退。然而，随着时间的推移，通过多次注射，患者可能会出现更为 医生简介 Emily Schehlein, MD | Brighton Vision Center, Brighton, Michigan | emschehlein@gmail.com Christina Y. Weng, MD, MBA | Professor of Ophthalmology, Fellowship Program Director, Vitreoretinal Diseases & Surgery, Baylor College of Medicine, Houston, Texas | christina.weng@bcm.edu 声明Schehlein: Perceptron Health, Glaukos, Allergan Weng: AGTC, Allergan/Abbvie, Alcon, Alimera Sciences, Apellis Pharmaceuticals, Iveric Bio, Novartis, REGENXBIO, Regeneron, DORC, DRCR Retina Network, Genentech, EyePoint, Springer Publishers 参考文献 1. Shah SM, al. Risk, prevalence, and progression of glaucoma in eyes with age-related macular degeneration treated with intravitreal anti-vascular endothelial growth factor injections. Am J Ophthalmol. 2022;243:98–108. 2. Islam YFK, et al. Glaucoma drainage device erosions in patients receiving anti-vascular endothelial growth factor therapy for diabetic retinopathy. Clin Ophthalmol. 2022;16:3681–3687. 3. de Vries VA, et al. The effects of intravitreal injections on intraocular pressure and retinal nerve fiber layer: a systematic review and meta-analysis. Sci Rep. 2020;10:13248. 4. Good TJ, et al. Sustained elevation of intraocular pressure after intravitreal injections of anti-VEGF agents. Br J Ophthalmol. 2011;95:1111–1114. 5. Bakri SJ, et al. Intraocular pressure in eyes receiving monthly ranibizumab in 2 pivotalage-related macular degeneration clinical trials. Ophthalmology. 2014;121:1102–1108. 6. Eadie BD, et al. Association of repeated intravitreous bevacizumab injections with risk for glaucoma surgery. JAMA Ophthalmol. 2017;135:363–368. 7. Chang EK, et al. Effects of postoperative intravitreal injections on outcomes of traditional glaucoma surgery in patients with preoperative intravitreal injections. Ophthalmol Glaucoma. 2022;5:219–228. 8. Lam LA, et al. Intravitreal injection therapy: current techniques and supplemental services. J Vitreoretin Dis. 2021;5:438–447. 9. Liu KC, et al. Recurrent tube erosions with anti-vascular endothelial growth factor therapy in patients with age-related macular degeneration. Ophthalmol Glaucoma. 2020;3:295–300. 10. Pirinen I, et al. Glaucoma progression in patients receiving intravitreal anti-VEGF treatment for neovascular age-related macular degeneration. Acta Ophthalmol. 2023;101:261–265. 11. Du J, et al. Effects of intravitreal anti-VEGF therapy on glaucoma-like progression in susceptible eyes. J Glaucoma. 2019;28:1035–1040. 12. Hoang QV, et al. Effect on intraocular pressure in patients receiving unilateral intravitreal anti-vascular endothelial growth factor injections. Ophthalmology. 2012;119:321– 326. 13. Wen JC, et al. Intravitreal anti-VEGF injections reduce aqueous outflow facility in patients with neovascular age-related macular degeneration. Invest Ophthalmol Vis Sci. 2017;58:1893–1898. 14. Bilgic A, et al. Sustained intraocular pressure rise after the treat and extend regimen at 3 years: aflibercept versus ranibizumab. J Ophthalmol. 2020;2020:7462098. 15. Cui QN, et al. Repeated intravitreal injections of antivascular endothelial growth factors and risk of intraocular pressure medication use. Graefe’s Arch Clin Exp Ophthalmol. 2019;257:1931–1939. 16. Matlach J, et al. Investigation of intraocular pressure fluctuation as a risk factor of glaucoma progression. Clin Ophthalmol. 2018;13:9–16. 17. El Chehab H, et al. Effect of topical pressure-lowering medication on prevention of intraocular pressure spikes after intravitreal injection. Eur J Ophthalmol. 2013;23:277– 283. 18. Hård Af Segerstad P. Risk model for intraoperative complication during cataract surgery based on data from 900,000 eyes: previous intravitreal injection is a risk factor. Br J Ophthalmol. 2022;106:1373–1379. 19. Khanani AM, et al. Efficacy and safety of avacincaptad pegol in patients with geographic atrophy (GATHER2): 12-month results from a randomised, double-masked, phase 3 trial. Lancet. 2023;402:1449–1458. 20. Jaffe GJ, et al. C5 inhibitor avacincaptad pegol for geographic atrophy due to age-related macular degeneration: a randomized pivotal phase 2/3 trial. Ophthalmology. 2021;128:576–586. 本文最初发表在2024年3月期EyeWorld。获得ASCRS Ophthalmic Services Corp批准，稍轻修改发表于此。 慢性的眼压升高。“抑制补体系统的干性AMD/GA的新治疗方案与 目前的抗VEGF IVI非常相似，进行这些注射的眼科医生会很熟悉，” 她说。“因此，正如临床试验所示，很可能有一部分患者在注射后会 出现短暂的眼压飙升。”她补充说，关于这些药物的长期影响的数据 很少，因此每次注射和临床就诊时测量眼压，对这些患者是很重要 的。17,20 “对于这些较新的药物，目前的指南是每月或每两个月注射一次， 对许多患者来说，可能会永久持续，”Dr. Schehlein说。“由于有一 些数据表明，注射次数的增加会增加青光眼手术的风险，而且这种 新药对眼压的长期影响尚不清楚，临床医生应该持续监测患者的眼 压，并谨慎对待晚期青光眼患者。值得考虑的是，开始使用这些新药 的青光眼患者是否应该更频繁地进行青光眼检测，或者是有青光眼 家族史、疑似青光眼或高眼压症的患者在接受这些新的注射药物时 应该定期进行基线检测。”根据早期数据和经验，Dr.Schehlein的做 法是密切监测眼压，尤其是中晚期青光眼患者，可以尽早重复检测， 并在眼压升高时增加治疗、激光或手术。她补充说，这些新的GA和干 性AMD的IVI治疗的副作用是前房炎症，青光眼专科医生应该在定期 检查时注意这一点。 青光眼
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