본문 바로가기
KERD
논문KCI 등재

안과 전공의가 시행한 유리체내 주입술의 단기간 안전성 고찰

Short-term Safety Evaluation of Resident-performed Intravitreal Injection

김하경|배소현|윤창기|마대중|배영환
대한안과학회 (The Korean Ophthalmological Society)|2021.11|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제62권 제11호|pp. 1509-1517

0

조회

0

다운로드

0

인용

0

참고문헌

키워드

Intravitreal injectionResident performedShort term safety
주제분류안과학

초록

목적: 안과 전공의가 시행한 유리체내 주입술의 단기 안정성을 확인해보고자 한다. 대상과 방법: 2018년 1월부터 2020년 10월까지 본원에서 안과 전공의 및 망막 전문의에게 베바시주맙, 라니비주맙, 애플리버셉트 및 트리암시놀론 아세토나이드 유리체내 주입술을 처음으로 시행 받은 503명의 503안의 의무기록을 후향적으로 분석하였다. 결과: 총 503안 중 안과 전공의가 211안(전공의군), 망막 전문의가 292안(망막 전문의군)에 유리체내 주입술을 시행하였다. 두 군 간의 주사 전 임상양상의 차이는 원인 질환의 빈도를 제외하고 관찰되지 않았다. 안압상승은 전공의군에서 2안(0.95%), 망막 전문의군에서 5안(1.71%) 발생하였으나, 두 군 간의 유의한 차이는 없었다. 결막하 출혈은 전공의군에서 29안(13.74%), 망막 전문의군에서 32안(10.96%) 발생하였으나, 두 군 간의 유의한 차이는 없었다. 비감염성 안내염은 전공의군에서는 발생하지 않았고, 망막 전문의군에서 2안(0.68%) 발생하였으나, 두 군 간의 유의한 차이는 없었다. 감염성 안내염은 전공의군에서 2안(0.95%), 망막 전문의군에서 1안(0.34%) 발생하였으나, 두 군 간의 유의한 차이는 없었다. 두 군 모두에서 각막미란, 외상성 수정체 손상, 유리체출혈, 망막열공 및망막박리는 발생하지 않았다. 결론: 단기간의 안구 합병증의 발생 빈도를 평가하였을 때, 안과 전공의가 유리체내 주입술을 시행하여도 안전할 것으로 생각된다.

Abstract

Purpose: This study evaluated the short-term safety of resident-performed intravitreal injections. Methods: We retrospectively reviewed the medical records of 503 patients (503 eyes) treated for the first time in our hospital from January 2018 to October 2020 via intravitreal bevacizumab, ranibizumab, aflibercept, or triamcinolone acetonide injections by residents or retina specialists. In terms of short-term ophthalmic complications, patients were followed-up 1 day, 1 week, and 1 month after injection. Results: A total of 503 eyes of 503 patients were included. Intravitreal injections were given to 211 and 292 eyes by residents (the resident group) and retina specialists (the retina specialist group), respectively. There were no between-group differences in baseline characteristics except in terms of the indications for injection. Intraocular pressure elevation >5 mmHg occurred in two eyes (0.95%) in the resident group and five (1.71%) in the retina specialist group, but the difference was not statistically significant. Subconjunctival hemorrhage occurred in 29 eyes (13.74%) of the resident group and 32 eyes (10.96%) of the retina specialist group; again, the difference was not statistically significant. No case of noninfectious endophthalmitis occurred in the resident group but two (0.68%) cases occurred in the retina specialist group; again, the difference was not significant. There were two (0.95%) cases of infectious endophthalmitis in the resident group and one (0.34%) case in the retina specialist group; again, the difference was not significant. No corneal erosion, traumatic lens damage, vitreous hemorrhage, or retinal tearing or detachment were noted in either group. Conclusions: Resident-performed intravitreal injections appear to be safe.

참고문헌 (46)

  1. Cheung GC, "Diabetic macular oedema : evidence-based treatment recommendations for Asian countries", Clin Exp Ophthalmol, 46, pp.75~86 (2018)
  2. Jiang Y, "Update on the use of anti-vegf intravitreal therapies for retinal vein occlusions", Asia Pac J Ophthalmol(Phila), 6, pp.546~553 (2017)
  3. Lim LS, "Age-related macular degeneration", Lancet, 379, pp.1728~1738 (2012)
  4. Lee JY, "Effect of alternate treatment with intravitreal anti-vascular endothelial growth factor and steroid for treatment-naive diabetic macular edema in a real-life setting", J Ocul Pharmacol Ther, 36, pp.555~562 (2020)
  5. Williams GA, "IVT injections : health policy implications", Rev Ophthalmol, 21, pp.62~64 (2014)
  6. Falavarjani KG, "Endophthalmitis after resident-performed intravitreal bevacizumab injection", Can J Ophthalmol, 50, pp.33~36 (2015)
  7. Falavarjani KG, "Adverse events and complications associated with intravitreal injection of anti-VEGF agents : a review of literature", Eye(Lond), 27, pp.787~794 (2013)
  8. Shikari H, "Complications of intravitreal injections in patients with diabetes", Semin Ophthalmol, 29, pp.276~289 (2014)
  9. Gupta A, "Complications of intravitreous injections in patients with diabetes", Semin Ophthalmol, 33, pp.42~50 (2018)
  10. Ziemssen F, "Reporting of safety events during anti-VEGF treatment : pharmacovigilance in a noninterventional trial", J Ophthalmol, 2020, pp.8652370~ (2020)
  11. Simcock P, "A safety audit of the first 10000 intravitreal ranibizumab injections performed by nurse practitioners", Eye(Lond), 28, pp.1161~1164 (2014)
  12. Day HR, "Risk of infectious endophthalmitis from a resident-performed intravitreal injection", J Vitreoretin Dis, 5, pp.321~325 (2021)
  13. Orozco-Hernández A, "Acute sterile endophthalmitis following intravitreal bevacizumab : case series", Clin Ophthalmol, 8, pp.1793~1799 (2014)
  14. Patel SN, "The impact of physician face mask use on endophthalmitis after intravitreal anti-vascular endothelial growth factor injections", Am J Ophthalmol, 222, pp.194~201 (2021)
  15. Greenberg JP, "Aflibercept-related sterile intraocular inflammation outcomes", Ophthalmol Retina, 3, pp.753~759 (2019)
  16. 조송희, "당뇨망막병증에서 항혈관내피성장인자의 국내 사용 현황: 국민건강보험공단 자료 분석", 대한안과학회지, 60(7), pp.661~666 (2019), 대한안과학회
  17. Avery RL, "Intravitreal injection technique and monitoring : updated guidelines of an expert panel", Retina, 34(Suppl 12), pp.S1~S18 (2014)
  18. Grzybowski A, "2018 update on intravitreal injections : euretina expert consensus recommendations", Ophthalmologica, 239, pp.181~193 (2018)
  19. Tabandeh H, "Endophthalmitis associated with intravitreal injections : office-based setting and operating room setting", Retina, 34, pp.18~23 (2014)
  20. Miño de Kaspar H, "Prospective randomized comparison of 2 different methods of 5% povidone-iodine applica-tions for anterior segment intraocular surgery", Arch Ophthalmol, 123, pp.161~165 (2005)
  21. Stranz CV, "Survival of bacteria on the ocular surface following double application of povidone-iodine before cataract surgery", Eye(Lond), 25, pp.1423~1428 (2011)
  22. Wykoff CC, "Allergy to povidone-iodine and cephalosporins : the clinical dilemma in ophthalmic use", Am J Ophthalmol, 151, pp.4~6 (2011)
  23. Gragoudas ES, "Pegaptanib for neovascular age-related macular degeneration", N Engl J Med, 351, pp.2805~2816 (2004)
  24. Xu Y, "Ocular pharmacokinetics of bevacizumab in vitrectomized eyes with silicone oil tamponade", Invest Ophthalmol Vis Sci, 53, pp.5221~5226 (2012)
  25. Tufan HA, "Bacterial contamination of needles used for intravitreal injections : comparison between 27-gauge and 30-gauge needles", Ocul Immunol Inflamm, 21, pp.366~370 (2013)
  26. Uhr JH, "Current practice preferences and safety protocols for intravitreal injection of anti-vascular endothelial growth factor agents", Ophthalmol Retina, 3, pp.649~655 (2019)
  27. Storey P, "The role of topical antibiotic prophylaxis to prevent endophthalmitis after intravitreal injection", Ophthalmology, 121, pp.283~289 (2014)
  28. Cheung CS, "Incidence of endophthalmitis and use of antibiotic prophylaxis after intravitreal injections", Ophthalmology, 119, pp.1609~1614 (2012)
  29. Bhatt SS, "Prophylactic antibiotic use after intravitreal injection : effect on endophthalmitis rate", Retina, 31, pp.2032~2036 (2011)
  30. Kim SJ, "Antimicrobial resistance and ophthalmic antibiotics : 1-year results of a longitudinal controlled study of patients undergoing intravitreal injections", Arch Ophthalmol, 129, pp.1180~1188 (2011)
  31. Raman V, "Safety of nurse-led intravitreal injection of dexamethasone (Ozurdex) implant service. Audit of first 1000 cases", Eye(Lond), 35, pp.388~392 (2021)
  32. Fukuyama J, "Causes of subconjunctival hemorrhage", Ophthalmologica, 200, pp.63~67 (1990)
  33. Yun C, "Subconjunctival hemorrhage after intravitreal injection of anti-vascular endothelial growth factor", Graefes Arch Clin Exp Ophthalmol, 253, pp.1465~1470 (2015)
  34. Hollands H, "Short-term intraocular pressure changes after intravitreal injection of bevacizumab", Can J Ophthalmol, 42, pp.807~811 (2007)
  35. Mojica G, "Short-term intraocular pressure trends following intravitreal injections of ranibizumab(Lucentis)for the treatment of wet age-related macular degeneration", Br J Ophthalmol, 92, pp.584~ (2008)
  36. Bakri SJ, "Immediate intraocular pressure changes following intravitreal injections of triamcinolone, pegaptanib, and bevacizumab", Eye(Lond), 23, pp.181~185 (2009)
  37. Yannuzzi NA, "Predictors of sustained intraocular pressure elevation in eyes receiving intravitreal anti-vascular endothelial growth factor therapy", Am J Ophthalmol, 158, pp.319~327 (2014)
  38. Meyer CH, "Incidence of damage to the crystalline lens during intravitreal injections", J Ocul Pharmacol Ther, 26, pp.491~495 (2010)
  39. Smiddy WE, "Lens and peripheral retinal relationships during vitrectomy", Retina, 11, pp.199~203 (1991)
  40. Daien V, "Incidence and outcomes of infectious and noninfectious endophthalmitis after intravitreal injections for age-related macular degeneration", Ophthalmology, 125, pp.66~74 (2018)
  41. Jonas JB, "Infectious and noninfectious endophthalmitis after intravitreal bevacizumab", J Ocul Pharmacol Ther, 23, pp.240~242 (2007)
  42. Mason JO 3rd, "Incidence of acute onset endophthalmitis following intravitreal bevacizumab(Avastin)injection", Retina, 28, pp.564~567 (2008)
  43. Pilli S, "Endophthalmitis associated with intravitreal anti-vascular endothelial growth factor therapy injections in an office setting", Am J Ophthalmol, 145, pp.879~882 (2008)
  44. Otsuka H, "Particle-induced endophthalmitis : possible mechanisms of sterile endophthalmitis after intravitreal triamcinolone", Invest Ophthalmol Vis Sci, 54, pp.1758~1766 (2013)
  45. Johnson D, "Incidence and characteristics of acute intraocular inflammation after intravitreal injection of bevacizumab : a retrospective cohort study", Can J Ophthalmol, 45, pp.239~242 (2010)
  46. Celik N, "Complications of dexamethasone implants : risk factors, prevention, and clinical management", Int J Ophthalmol, 13, pp.1612~1620 (2020)

관련 논문AI추천

양안 동시 유리체강 내 베바시주맙주입술의 단기간 안전성 고찰손준홍, 안자영, 장규환, 황덕진대한안과학회 · 대한안과학회지2020 · 제61권 제10호유리체강 내 라니비주맙, 애플리버셉트주입술 후 안압상승에 대한 분석문태규, 박상우, 성미선, 하준영대한안과학회 · 대한안과학회지2019 · 제60권 제4호유리체강 내 베바시주맙, 트리암시놀론 및 혼합약제 주입 후 장기간 안압변동 관찰성민철, 신용운, 이윤정, 조희윤대한안과학회 · 대한안과학회지2011 · 제52권 제5호유리체강내 트리암시놀론 아세토나이드 주사 합병증에 대한 다각적 고찰: 발생률 및 위험요소강행구, 진희승대한안과학회 · 대한안과학회지2012 · 제53권 제1호용량에 따른 유리체강내 트리암시놀론 주입과 베바시주맙 주입이 안압에 미치는 영향박성배, 박종서, 하성우대한안과학회 · 대한안과학회지2010 · 제51권 제11호펜타캠을 이용한 유리체강내 주입술 후전방인자 변화 분석김병선, 김성재, 김체론, 박종문, 서성욱, 유지명, 정인영, 한용섭대한안과학회 · 대한안과학회지2013 · 제54권 제12호

이 간행물의 다른 논문 (14건)

혈청 갑상샘자극호르몬수용체 자가항체와 갑상샘눈병증의 중증도 및 활동성과의 관계이시형, 장선영, 이제상, 김보연pp. 1459-1464복합 세균각막염과 단일 세균각막염의 임상 비교 분석이상범, 조찬호, 백승철pp. 1465-1477중등도 근시에서 라섹수술 받은 환자의 연령에 따른 단기 굴절 변화 비교박규홍, 정성근, 문자윤, 김미정, 김희영, 최진석, 안지선pp. 1478-1482신생혈관녹내장에서 발생한 친수성 아크릴 인공수정체혼탁의 임상양상한동진, 정인권, 신주연, 서지원, 이종현, 이도형, 최헌진pp. 1483-1489나이관련황반변성과 당뇨황반부종에서 브루크막 개방 최소 시신경유두테 폭의 반복성김범준, 한용섭, 남기엽, 강태신, 김지혜, 조현경, 이우혁pp. 1490-1501
원문 보기