玻璃体腔内注射贝伐单抗治疗新生血管性年龄相关性黄斑变性后视网膜色素上皮撕裂

Retinal pigment epithelial tears after intravitreal bevacizumab injection for neovascular age-related macular degeneration.

作者信息

Chan Clement K, Meyer Carsten H, Gross Jeffrey G, Abraham Prema, Nuthi Asha S D, Kokame Gregg T, Lin Steven G, Rauser Michael E, Kaiser Peter K

机构信息

Southern California Desert Retina Consultants, Palm Springs, CA 92263, USA.

出版信息

Retina. 2007 Jun;27(5):541-51. doi: 10.1097/IAE.0b013e3180cc2612.

DOI:10.1097/IAE.0b013e3180cc2612

PMID:17558314

Abstract

PURPOSE

To study retinal pigment epithelium (RPE) tears after off-label intravitreal bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA) injection for neovascular age-related macular degeneration. Eyes with a vascularized pigment epithelial detachment (PED) that developed an RPE tear were compared with eyes with a vascularized PED but without an RPE tear.

METHODS

Nine retina specialists across the United States and in Europe participated in this retrospective case series. All eyes that received intravitreal bevacizumab injection for choroidal neovascularization (CNV) over 12 months (October 2005 to September 2006) were included. Eyes without all three confirmed tests (fluorescein angiography, fundus photography, and optical coherence tomography) were excluded from analysis. Statistical analyses were performed on multiple characteristics of eyes with a vascularized PED that did and did not develop an RPE tear.

RESULTS

Among 2,785 intravitreal bevacizumab injections for 1,064 eyes, RPE tears were found in 22 eyes in 22 patients (2.2%). A vascularized PED was present in 21 of 22 eyes that developed an RPE tear (17.1% of PED eyes; 15, 100% occult CNV; 6, predominantly occult CNV). Mean interval from bevacizumab injections to RPE tears was 37.3 days. Mean follow-up time was 124.9 days. Mean subfoveal PED size was larger for eyes with tears than for those without tears (13.97 mm vs 9.9 mm, respectively; P = 0.01; odds ratio, 1.09). There was substantially smaller mean ratio of CNV size to PED size for eyes with tears than for those without tears (27.9% vs 67.6%, respectively; P = 0.005). Mean pre-bevacizumab injection best-corrected Snellen visual acuity was 20/162, and mean post-RPE tear best-corrected visual acuity was 20/160 (P = 0.48).

CONCLUSION

Large PED size is a predictor for RPE tears, and a small ratio of CNV size to PED size (<50%) is more common in eyes with RPE tears. Vision may be preserved despite RPE tears.

摘要

目的

研究玻璃体腔注射贝伐单抗（阿瓦斯汀；基因泰克公司，加利福尼亚州南旧金山）治疗新生血管性年龄相关性黄斑变性后视网膜色素上皮（RPE）撕裂情况。将发生RPE撕裂的有血管化色素上皮脱离（PED）的眼与有血管化PED但未发生RPE撕裂的眼进行比较。

方法

美国和欧洲的9位视网膜专家参与了这个回顾性病例系列研究。纳入了在12个月内（2005年10月至2006年9月）接受玻璃体腔注射贝伐单抗治疗脉络膜新生血管（CNV）的所有眼。未进行全部三项确诊检查（荧光素血管造影、眼底照相和光学相干断层扫描）的眼被排除在分析之外。对有血管化PED且发生和未发生RPE撕裂的眼的多项特征进行了统计分析。

结果

在对1064只眼进行的2785次玻璃体腔注射贝伐单抗治疗中，22例患者的22只眼发生了RPE撕裂（2.2%）。发生RPE撕裂的22只眼中有21只存在血管化PED（占PED眼的17.1%；15只，100%隐匿性CNV；6只，主要为隐匿性CNV）。从注射贝伐单抗到发生RPE撕裂的平均间隔时间为37.3天。平均随访时间为124.9天。发生撕裂的眼的黄斑中心凹下PED平均大小大于未发生撕裂的眼（分别为13.97mm和9.9mm；P = 0.01；比值比，1.09）。发生撕裂的眼的CNV大小与PED大小的平均比值明显小于未发生撕裂的眼（分别为27.9%和67.6%；P = 0.005）。注射贝伐单抗前的平均最佳矫正视力为20/162，发生RPE撕裂后的平均最佳矫正视力为20/160（P = 0.48）。