Southern California Desert Retina Consultants, Palm Springs, California 92263, USA.
Retina. 2010 Feb;30(2):203-11. doi: 10.1097/IAE.0b013e3181babda5.
The purpose was to study preinjection optical coherence tomography-related factors in age-related macular degeneration eyes with retinal pigment epithelial detachment (PED) that may predispose retinal pigment epithelial (RPE) tears associated with intravitreal bevacizumab injections.
This multicenter retrospective case series involving 9 retina specialists and 7 centers investigated Stratus optical coherence tomography (Carl Zeiss Meditec, Dublin, CA) parameters in eyes with vascularized PED (vPED) from February 2006 to February 2007. Of the 1,280 eyes in 1,255 patients receiving 2,890 intravitreal injections, there were 125 eyes with vPED. For every vPED eye that developed an RPE tear (Group 1), 3 or more vPED eyes without RPE tears (Group 2) were randomly selected in each study center during the same time period for comparison. The primary outcome measure was PED height (microm), and the secondary measures included volume index (vPED height x surface area), total macular volume, subretinal fluid, cystoid macular edema, center-point thickness, central 1 mm, and pre- and postinjection best-corrected Snellen visual acuities.
Twenty-one vPED eyes in 21 patients among 125 vPED eyes (16.8% of all vPED eyes) developed RPE tears. The 21 Group 1 eyes were compared with the 78 randomly selected Group 2 eyes. The vPED height was significantly higher for Group 1 eyes in comparison to Group 2 eyes (mean: 648.9 +/- 245.0 vs. 338.1 +/- 201.6 microm, P < 0.001). The same was true for the following: volume index (P = 0.001), subretinal fluid (P = 0.002), and total macular volume (P = 0.04). The mean preinjection and post-RPE tear best-corrected visual acuity were 0.92 logMAR (20/166) and 0.84 logMAR (20/137), respectively (P = 0.25). Multivariate analysis showed PED height to be the only significant risk factor associated with RPE tears in Group 1 eyes [odds ratio = 0.995 (95% confidence interval: 0.992-0.997), P < 0.001].
Elevated preinjection vPED height is the single most significant predictor for RPE tears after bevacizumab injections for vPED eyes. A vPED height >400 microm is associated with a significant risk for such a complication.
本研究旨在探讨年龄相关性黄斑变性伴视网膜色素上皮脱离（PED）患者接受玻璃体内贝伐单抗注射前的光学相干断层扫描（OCT）相关因素，这些因素可能导致与玻璃体内贝伐单抗注射相关的视网膜色素上皮（RPE）撕裂。
本多中心回顾性病例系列研究纳入了 9 名视网膜专家和 7 家中心，于 2006 年 2 月至 2007 年 2 月期间，使用 Stratus OCT（Carl Zeiss Meditec，Dublin，CA）对伴有血管性 PED（vPED）的患者进行检查。在接受了 2890 次玻璃体内注射的 1255 例患者的 1280 只眼中，有 125 只眼出现 vPED。在每只出现 RPE 撕裂的 vPED 眼中（第 1 组），均随机选择同期每个研究中心的 3 只或更多未出现 RPE 撕裂的 vPED 眼（第 2 组）进行比较。主要观察指标为 PED 高度（μm），次要观察指标包括容积指数（vPED 高度×表面积）、总黄斑容积、视网膜下积液、囊样黄斑水肿、中心凹厚度、中央 1mm 区、注射前后最佳矫正视力的 Snellen 对数视力。
在 125 只 vPED 眼中的 21 只（所有 vPED 眼中的 16.8%）出现了 RPE 撕裂。第 1 组的 21 只眼与随机选择的第 2 组的 78 只眼进行了比较。与第 2 组相比，第 1 组的 vPED 高度明显更高（平均：648.9±245.0μm 比 338.1±201.6μm，P＜0.001）。容积指数（P=0.001）、视网膜下积液（P=0.002）和总黄斑容积（P=0.04）也存在相同趋势。第 1 组注射前后最佳矫正视力的平均 logMAR 值分别为 0.92（20/166）和 0.84（20/137）（P=0.25）。多变量分析显示，PED 高度是与第 1 组眼 RPE 撕裂相关的唯一显著危险因素[比值比=0.995（95%置信区间：0.992-0.997），P＜0.001]。
玻璃体内贝伐单抗注射治疗 vPED 眼后，注射前 vPED 高度升高是导致 RPE 撕裂的唯一最显著预测因素。PED 高度＞400μm 与发生此类并发症的显著风险相关。
