反复玻璃体腔注射雷珠单抗与阿柏西普对黄斑水肿患者角膜神经的影响

Effect of repeated intravitreal Ranibizumab and Aflibercept injections on the corneal nerves in patients with macular edema

摘要:

目的：探讨反复玻璃体腔注射雷珠单抗与阿柏西普对黄斑水肿患者角膜神经的影响。

方法：选取2021-06/2022-06在我院进行玻璃体腔注射抗血管内皮生长因子(VEGF)药物治疗的患者64例64眼，其中糖尿病性黄斑水肿20例20眼，湿性年龄相关性黄斑变性19例19眼，视网膜静脉阻塞25例25眼。采取3+PRN治疗方案，注药前和每次玻璃体腔注药后1mo时采用共聚焦显微镜采集角膜上皮基底膜下神经丛图像，测量角膜神经纤维长度和密度。

结果：玻璃体腔注射阿柏西普的患者注药前后术眼角膜神经纤维密度无显著变化(P>0.05)，但第2、3次注药后角膜神经纤维长度均低于注药前(均P<0.01)； 玻璃体腔注射雷珠单抗的患者注药前后术眼角膜神经纤维密度和长度均无显著变化(均P>0.05)。第3次注药后，两组患者术眼角膜神经纤维长度和密度均无显著差异(均P>0.05)。

结论：反复玻璃体内注射抗VEGF药物会一定程度影响角膜神经，对多次注射抗VEGF药物的患者需关注角膜神经变化。

Abstract:

AIM: To investigate the effect of repeated intravitreal injection of ranibizumab and aflibercept on corneal nerve of patients with macular edema.

METHODS: A total of 64 patients(64 eyes)enrolled in our hospital from June 2021 to June 2022 were treated with intravitreal injection of anti-vascular endothelial growth factor(VEGF). There were 20 cases(20 eyes)of diabetic macular edema, 19 cases(19 eyes)of wet age-related macular degeneration and 25 cases(25 eyes)of retinal vein occlusion. Corneal confocal microscope was used to collect images of corneal subbasal nerve plexus before injections and at 1mo after each intravitreal injection based on 3+pro re nata(PRN)treatment regimen. Furthermore, the length and density of corneal nerve were measured.

RESULTS: There was no significant difference in corneal nerve density of patients injected with aflibercept between pre-injection and post-injection(P>0.05), while the corneal nerve length after 2^nd and 3^rd injections was lower than that of pre-injection(all P<0.01). There were no significant changes in corneal nerve density and length in patients with intravitreal injections of ranibizumab(all P>0.05), and there was no significant differences in corneal nerve density and length after 3 injections of the two drugs(all P>0.05).

CONCLUSION: Repeated intravitreal anti-VEGF drug may affect corneal nerve to some extent. For patients who need repeated intravitreal injections of anti-VEGF, attention should be paid to the changes of corneal nerves.