探讨玻璃体腔注药术后早期测量眼压的必要性。

收集2021年7月22日至2021年8月31日于首都医科大学附属北京同仁医院眼科中心接受玻璃体腔注药手术的患者1018例(1193只眼)。其中，男性506例(597只眼)，女性512例(596只眼)；年龄9~99岁，平均年龄(60.2±13.9)岁。登记全部患者的性别、年龄、眼别、疾病种类及注射药物的品种，测量并记录其注药前后的眼压。年龄和眼压以±s描述。各眼压区段、各病种及各注药品种中患眼的分布情况采用眼数和百分比表示。以配对t检验比较各病种及各注药品种注药前后眼压的差异。

全部1193只眼中，眼压_{术后30 min}≤25mmHg(1 mmHg＝0.133 kPa)者共计1183只眼，占99.16%。其中，糖尿病视网膜病变(DR)556只眼，占47.00%，湿性年龄相关性黄斑变性(AMD)304只眼，占25.70%，非湿性AMD的其他脉络膜新生血管(CNV)35只眼，占2.96%，视网膜静脉阻塞(RVO)247只眼，占22.81%，新生血管性青光眼( NVG)15只眼，占1.39%，其他疾病26只眼，占2.20%。眼压_{术后30 min}>25 mmHg者仅有10只眼。其中，眼压在26~30 mmHg者3只眼，眼压在31~40 mmHg者6只眼，眼压>40 mmHg者1只眼；病种为RVO者1只眼，DR1只眼，湿性AMD2只眼，NVG6只眼。此NVG6只眼的眼压_术前为(43.67±8.71)mmHg。眼压_{术后30 min}>40 mmHg者仅有1只眼，使用降眼压药物30 min后眼压降为40 mmHg；其余NVG5只眼，眼压_{术后30 min}在26~40 mmHg之间。眼压_{术后30 min}>25 mmHg中另外非NVG的4只眼，继续观察30 min或60 min后，眼压均将至25 mmHg以下。玻璃体腔注射雷珠单抗和康柏西普的患眼眼压_术前分别为(15.51±4.71)mmHg和(15.03±3.79)mmHg；眼压_{术后30 min}分别为(17.00±4.81)mmHg和(16.62±4.14)mmHg。经配对t检验，两组术前与术后30 min眼压比较的差异具有统计学意义(t＝-5.551，-6.187；P<0.05)。地塞米松玻璃体腔缓释植入剂玻璃体腔注射的患眼，眼压_术前为(14.80±2.59)mmHg，眼压_{术后30 min}为(14.80±2.59)mmHg。经配对t检验，其术前与术后30 min眼压比较的差异无统计学意义(t＝0.279，P>0.05)。此外，注射阿柏西普、地塞米松玻璃体腔缓释剂联合雷珠单抗及地塞米松玻璃体腔缓释剂联合康柏西普的患眼分别为21只眼、18只眼及2只眼，眼压_术前分别为(14.95±2.56)mmHg、(14.44±2.30)mmHg及(16.00±2.83)mmHg，眼压_{术后30 min}分别为(17.04±3.46)mmHg、(14.11±4.96)mmHg及(16.50±0.71)mmHg。本研究NVG患眼共有21只眼。眼压_术前为(37.76±6.97)mmHg，眼压_{术后30 min}为(22.00±8.77)mmHg。NVG患眼中原发病为增殖性DR者有14只眼，占66.67%，眼压_术前为(38.00±12.92)mmHg，眼压_{术后30 min}为(25.07±11.64)mmHg。原发病为视网膜中央静脉阻塞者有7只眼，占33.33%，眼压_术前为(37.29±4.82)mmHg，眼压_{术后30 min}为(15.00±5.89)mmHg。注射药物为雷珠单抗的有16只眼，占76.19%，眼压_术前为(37.56±7.95)mmHg，眼压_{术后30 min}为(23.00±12.20)mmHg。注射药物为康柏西普的有5只眼，占23.81%，眼压_术前为(38.40±2.30)mmHg，眼压_{术后30 min}为(18.00±5.43)mmHg。

常规玻璃体腔注药术后30 min眼压高于正常范围的几率极低，因此无须术后测量眼压。对于原本有青光眼的患者，如新生血管性青光眼，术后可监测眼压。

The aim of this study was to investigate the necessity of early intraocular pressure measurement after intravitreal injection.

From July 22 to August 31, 2021, 1018 consecutive patients (1193 eyes) who underwent intravitreal injection in Beijing Tongren Eye Center, Beijing Tongren Hospital Affiliated to Capital Medical University were collected. Among them, there were 506 male (597 eyes) and 512 female (596 eyes) with an average age of (60.2±13.9) years-old (ranged from 9 to 99 years-old). The gender, age, eye type, IOP, disease type and injected drugs of all patients were recorded. The intraocular pressure (IOP) before and after injection injection were measured. The data of age and IOP were expressed as ±s. The overall number of eyes and the number of eyes of different diseases in each IOP segment are expressed in descriptive statistics and percentage. The difference of IOP before and after injection were used to compared by paired t test.

After intravitreal injection for 30 mins, the IOP of 1183 eyes (99.16%) was less than or equal to 25 mmHg (1 mmHg=0.133 kPa). Among them, there were 556 eyes (47.00%) with diabetic retinopathy (DR), 304 eyes (25.70%) with wet age-related macular degeneration (AMD), 35 eyes (2.96%) with other choroidal neovascularization (CNV), 247 eyes (22.81%) with retinal vein occlusion (RVO), 15 eyes (1.39%) with neovascular glaucoma (NVG), and 26 eyes (2.20%) with other diseases. There were only 10 eyes with IOP over 25 mmHg, of which IOP of 3 eyes with 26 to 30 mmHg, 6 eyes with 31 to 40 mmHg, and 1 eye with over 40 mmHg. There were one eye with RVO, one eye with DR, 2 eyes with AMD, 6 eyes with NVG. The IOP was (43.67±8.71)mmHg in 6 eyes with NVG before injection. There was IOP of 1 eye more than 40 mmHg after injection for 30 mins and IOP decreased to 40 mmHg after using IOP reducing drugs. IOP of 5 NVG eyes was 26~40 mmHg after injection for 30 mins. After observation for half an hour or 1 hour, the IOP of 4 eyes with non-NVG decreased to less than 25mmHg. For ranibizumab, conbercept injection, the IOP before injection were (15.51±4.71)mmHg and (15.03±3.79)mmHg, respectively. The IOP after injection for 30 mins was (17.00±4.81)mmHg and (16.62±4.14)mmHg, respectively. There were significant differences in IOP between pre-injection and post-injection between groups by paired ttest (t=-5.551, - 6.187; P< 0.05). The IOP of Ozurdex injection group before and after injection was (14.80±2.59)mmHg, (14.80±2.59)mmHg, respectively. There was no significant difference between groups (t=0.279, P>0.05). There were 21 eyes, 18 eyes and 2 eyes in the aflibercept, Ozurdex combined with ranibizumab and Ozurdex combined with combercept groups, respectively. The preoperative IOP were (14.95±2.56)mmHg, (14.44±2.30)mmHg and (16.00±2.83)mmHg, respectively; the postoperative IOP were (17.04±3.46)mmHg, (14.11±4.96)mmHg and (16.50±0.71)mmHg, respectively. Preoperative and postoperative IOP of 21 eyes with NVG were (37.76±6.97)mmHg, (22.00±8.77)mmHg , respectively with significant difference between them by paired ttest (t=6.447, P<0.05). Preoperative and postoperative IOP of 14 eyes (66.67%) with proliferative DR were (38.00±12.92)mmHg, (25.07±11.64)mmHg, respectively. Preoperative and postoperative IOP of 7 eyes (33.33%) with CRVO were (37.29±4.82)mmHg, (15.00±5.89)mmHg, respectively. Preoperative and postoperative IOP of 16 eyes (76.19%) injected with ranibizumab were (37.56±7.95)mmHg, (23.00±12.20)mmHg, respectively. Preoperative and postoperative IOP of 5 eyes (76.19%) injected with conbercept were (38.40±2.30)mmHg, (18.00±5.43)mmHg

The probability of IOP higher than that after routine intravitreal injection for 30 mins is very low, thus it is unnecessary to measure IOP after intravitreal injection. For patients with glaucoma, such as glaucoma with NVG, IOP can be measured after injection.