Bilateral EĢzamanlı Ġntravitreal Enjeksiyonlarda Ġlaç ve Göz Spekulumunun Göziçi Basıncına Etkisi
Amaç: Bilateral aynı seansta intravitreal ranibizumab(IVR) ve aflibercept(IVA) enjeksiyonlarında göz spekulumunun (blefarosta) göziçi basıncı(GİB) değişimine etkisinin incelenmesi. Gereç ve Yöntem: Kesitsel tipteki çalışmaya göz polikliniğine diyabetik retinopati ve makula ödemi nedeniyle başvuran, IVR veya IVA yapılacak hastalar dahil edildi.Oküler cerrahi veya ilaç kullanım hikayesi olanlar çalışmaya alınmadı.Bir göze açık blefarosta(A),diğer göze kapalı blefarosta(K) uygulandı. Blefarosta takılmadan önce (AÖGİB,KÖGİB), takıldıktan sonra (ABGİB,KBGİB) ve enjeksiyon sonrası göziçi basıncı (AEGİB,KEGİB) kontakt el tonometresi ile ölçüldü. Bulgular: IVR grubunda 17 erkek,19 kadın,yaş ortalaması 67.0 ±8.5 yıl, IVA grubunda 18 erkek,18 kadın yaş ortalaması 64.90 ±6.32 yıldı.(p=0.12) IVR grubunda AÖGİB 18.07±4.60 mmHg, ABGİB 19.90 ± 5.59 mmHg, AEGİB 47.53 ±7.25 mmHg, KÖGİB 18.93 ±4.60 mmHg, KBGİB 22.33± 6.32 mmHg, KEGİB 52.07 ±2.62 mmHg iken IVA grubunda AÖGİB 17.17 ±3.24 mmHg, ABGİB 19.70 ±3.31mmHg, AEGİB 48.20 ±6.46 mmHg, KÖGİB 16.97±2.94 mmHg, KBGİB 19.57± 3.21 mmHg, KEGİB 39.70± 4.21 mmHg bulundu. AÖGİB,ABGİB,AEGİB,KÖGİB değerlerinde gruplararasında istatistiksel farklılık yoktu.(sırasıyla p değerleri 0.38, 0.86, 0.86, 0.054) KBGİB ve KEGİB değerleri IVA grubunda istatistiksel anlamlı düşük bulundu.(sırasıyla p değerleri 0.037, 0.001) IVR grubunda AÖGİB-ABGİB farkı -1.83± 1.85, AÖGİB-AEGİB farkı -29.46 ±12.47, ABGİB-AEGİB farkı - 27.63 ±12.60, KÖGİB-KBGİB farkı -3.40 ±3.57, KÖGİB-KEGİB -34.13 ±9.06, KBGİBKEGİB farkı -30.73 ±9.56 iken IVA grubunda AÖGİB-ABGİB farkı -2.53± 2.40, AÖGİBAEGİB farkı 31.03 ±16.96, ABGİB-AEGİB farkı -28.50 ±16.89, KÖGİB-KBGİB farkı -2.60 ±2.52, KÖGİB-KEGİB farkı -22.73 ±19.05, KBGİB-KEGİB farkı -20.13 ±18.94 bulundu. Gruplararasında AÖGİB-ABGİB, AÖGİB-AEGİB, ABGİB-AEGİB, KÖGİB-KBGİB değerlerinde istatistiksel farklılık yoktu.(sırasıyla p değerleri 0.21,0.68,0.82,0.32) IVA grubunda KÖGİB-KEGİB, KBGİB-KEGİB değerleri istatistiksel anlamlı düşüktü.(sırasıyla p değerleri 0.004, 0.008). Sonuç: IVA grubunda kapalı blefarosta kullanılmasıyla daha az GİB değişimi sağlanabilmektedir.
Effects of Drug and Eye Speculum on the Intraocular Pressure in Bilateral Simultaneous Intravitreal Injection
Objective: Evaluation of the effects of intraocular pressure (IOP) changes on the eye speculum (blepharosta) in bilateral injections of intravitreal ranibizumab (IVR) and aflibercept (IVA). Methods: Patients with diabetic retinopathy and macular edema attented to the IVR and IVA were included in the study.Patients with ocular surgery or drug use history were not included. The intraocular pressure was measured by contact hand tonometry. IOP was measured before insertion of the blepharosta (OBIOP, CBIOP), after attachment (OAIOP,CAIOP) and after injection(OİIOP,CİIOP). Results: In the IVR group, 17 males and 19 females, mean age was 67.0 ± 8.5 years, 18 males and 18 females in the IVA group had a mean age of 64.90 ± 6.32 years.(p = 0.12) There was no statistically significant difference between the groups in terms of values of OBIOP, OAIOP, OİIOP, CBIOP (p values 0.38, 0.86, 0.86, 0.054 respectively). The values of CAIOP and CİIOP were statistically significantly lower in the IVA group (pvalues 0.037, 0.001 respectively). There were no statistically significant differences between the groups in terms of OBIOPOAIOP, OBIOP-OİIOP, OAIOP-OİIOP and CBIOP-CBIOP difference values (p values 0.21,0.68,0.82,0.32 respectively). The values of CBIOP-CİIOP and CAIOP-CİIOP difference were statistically significant (respectively p values of 0.004, 0.008). Conclusion: In the IVA group, the use of closed blepharosta allows less IOP exchange.
___
- Brand CS. Management of retinal vascular diseases: a patient-centric approach. Eye (Lond) 2012;26:1-16.
- Alakuş MF, Taş M, Öner V, et al. Diabetik Maküla Ödeminde İntravitreal Bevacizumab Etkinliğininin
Değerlendirilmesi. Retina Vitreus 2012;1:35-40
- Bakri SJ, Pulido JS, McCannel CA, Hodge DO, Diehl N, Hillemeier J. Immediate intraocular pressure
changes following intravitreal injections of triamcinolone, pegaptanib, and bevacizumab. Eye 2009;23:181-
185.
- Sharei V, Höhn F, Köhler T, et al. Course of intraocular pressure after intravitreal injection of 0.05 mL
ranibizumab (Lucentis). Eur J Ophthalmol 2010;20:174- 179.
- Kotliar K, Maier M, Bauer S, et al. Effect of intravitreal injections and volume changes on intraocular
pressure: clinical results and biomechanical model. Acta Ophthalmol Scand 2007;85:777-781.
- Gismondi M, Salati C, Salvetat ML, et al. Short term effect of intravitreal injection of Ranibizumab
(Lucentis) on intraocular pressure. J Glaucoma 2009;18:658- 661.
- Höhn F, Mirshahi A. Impact of injection techniques on intraocular pressure (IOP) increase after intravitreal
ranibizumab application. Graefes Arch Clin Exp Ophthalmol 2010;248:1371-1375.
- Meyer CH, Holz FG. Preclinical aspects of anti-VEGF agents for the treatment of wet AMD: ranibizumab and bevacizumab. Eye (Lond) 2011;25:661-672
- Satıcı A, Oğuz H, Gürler B.: Göz içi basınç ölçümünde Goldmann aplanasyon tonometresi ile Tono-Pen ve
nonkontakt tonometre değerlerinin karşılaştırılması. T Oft Gaz. 1997;27:321-324.
- Özdemir N, Tekin A, Ersöz TR. et al.: Tono-Pen tonometresi ile Goldmann applanasyon tonometresinin
klinik larak karşılaştırılması. MN Ophthalmology. 1997;4:168-170.
- Shingleton BJ, Pasternack JJ, Hung JW, O‘Donoghue MW. Three- and five year changes in intraocular
pressures after clear corneal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and
normal patients. J Glaucoma 2006;15:494-498.
- Poley BJ, Lindstrom RL, Samuelson TW. Long term effects of phacoemulsification with intraocular lens
implantation in normotensive and ocular hypertensive eyes. J Cataract Refract Surg 2008;34:735-742.
- Kerimoglu H, Ozturk BT, Bozkurt B, et al. Does lens status affect the course of early intraocular pressure and
anterior chamber changes after intravitreal injection? Acta Ophthalmol 2011;89:138-142.
- Hollands H, Wong J, Bruen R, et al. Short-term intraocular pressure changes after intravitreal injection of
bevacizumab. Can J Ophthalmol 2007;42:807-811.
- Adelman RA, Zheng Q, Mayer HR. Anti-VEGF dials up the pressure: anti-VEGF therapy is an effective
treatment option for a variety of retinal conditions. However, it also may increase IOP, J Ocul Pharmacol
Ther. 2010 Feb;26(1):105-10.
- Good TJ, Kimura AE, Mandava N, et al. Sustained elevation of intraocular pressure after intravitreal
injections of anti-VEGF agents. Br J Ophthalmol. 2011 Aug;95(8):1111-4.
- Epley KD, Tychsen L, Lueder GT. The effect of an eyelid speculum on intraocular pressure measurement in
children. Am J Ophthalmol. 2002 Dec;134(6):926-7.
- Shahid E, Shaikh A. Effect of different eye speculums on intra ocular pressure. J Pak Med Assoc. 2013
Oct;63(10):1278-80.