Rocky Mountain Lions Eye Institute, Department of Ophthalmology, University of Colorado Denver School of Medicine, Aurora, CO 80045, USA.
Am J Ophthalmol. 2010 Oct;150(4):558-561.e1. doi: 10.1016/j.ajo.2010.04.029.
To evaluate the effects of multiple intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents on the thickness of the retinal nerve fiber layer (RNFL) in patients with wet age-related macular degeneration (ARMD).
Retrospective, observational, consecutive case series of patients diagnosed with wet ARMD.
Forty-one eyes of 37 consecutive patients (25 female and 12 male; mean age 79.2 ± 8.7 years) who underwent treatment with pegaptanib, bevacizumab, and/or ranibizumab for ARMD followed by sequential RNFL thickness measurement by optical coherence tomography (OCT) were studied. Patients were included in the analyses if they had greater than 10 total anti-VEGF injections, RNFL measurements prior to the first injection, and at least 12 months of follow-up. Patients were divided into 3 groups depending on which anti-VEGF agent(s) they received. The OCT RNFL measurements at the initial and final follow-up were used for analyses.
Average follow-up for all patients was 27.0 ± 9.7 months and they received an average of 16.0 ± 5.5 intravitreal injections. The average RNFL thickness at presentation was 92.4 ± 15.2 μm and at last follow-up was 93.8 ± 15.2 μm (P = .68). There were no statistically significant differences in RNFL measurements when comparing between individual anti-VEGF treatment groups.
Long-term treatment with anti-VEGF agents did not lead to significant changes in RNFL thickness in a patient population with wet ARMD. Despite the possibility of repeated intraocular pressure (IOP) fluctuations after intravitreal injections and known neurotrophic properties of VEGF in the eye, chronic therapy with intravitreal anti-VEGF agents does not appear to adversely affect RNFL thickness. Further prospective studies with longer follow-up are needed to corroborate the findings of this study.
评估多次玻璃体内注射抗血管内皮生长因子（VEGF）药物对湿性年龄相关性黄斑变性（AMD）患者视网膜神经纤维层（RNFL）厚度的影响。
回顾性、观察性、连续病例系列研究，纳入被诊断为湿性 AMD 的患者。
对 37 例连续患者的 41 只眼（25 名女性，12 名男性；平均年龄 79.2 ± 8.7 岁）进行了研究，这些患者接受了培加他滨、贝伐单抗和/或雷珠单抗治疗 AMD，并通过光学相干断层扫描（OCT）进行了连续的 RNFL 厚度测量。如果患者接受了超过 10 次的抗 VEGF 注射、首次注射前有 RNFL 测量值且随访时间超过 12 个月，则将其纳入分析。根据患者接受的抗 VEGF 药物（单药或联合用药）将患者分为 3 组。分析采用初始和最终随访时的 OCT RNFL 测量值。
所有患者的平均随访时间为 27.0 ± 9.7 个月，平均接受了 16.0 ± 5.5 次玻璃体内注射。就诊时的平均 RNFL 厚度为 92.4 ± 15.2 μm，末次随访时为 93.8 ± 15.2 μm（P =.68）。在比较各个抗 VEGF 治疗组时，RNFL 测量值无统计学差异。
在湿性 AMD 患者人群中，长期使用抗 VEGF 药物治疗不会导致 RNFL 厚度发生显著变化。尽管玻璃体内注射后眼压（IOP）可能会反复波动，且 VEGF 在眼内具有神经营养特性，但长期使用玻璃体内抗 VEGF 药物似乎不会对 RNFL 厚度产生不利影响。需要进一步进行前瞻性研究，以验证本研究的结果。
