Ophthalmology Department, University of Athens, ATTIKON Hospital, Athens, Greece.
Retina. 2011 May;31(5):871-9. doi: 10.1097/IAE.0b013e3182003ca8.
To evaluate the effect of individualized repeated intravitreal injections of ranibizumab (Lucentis) on visual acuity and central foveal thickness in patients with choroidal neovascular membrane (CNV) associated with various ocular inflammatory clinical entities.
Our study was a retrospective, noncomparative, interventional, and observational case series. Sixteen eyes of 15 consecutive patients diagnosed with inflammatory CNV treated with repeated intravitreal injections of ranibizumab were evaluated. The underlying diagnoses were toxoplasmosis (n = 4), serpiginous choroidopathy (n = 2), punctate inner choroidopathy (n = 5), multifocal choroiditis (MFC, n = 3), and scleroderma (n = 2). All patients underwent monthly optical coherence tomography (OCT) scans and fluorescein angiography/indocyanine green angiography every 1 month after every injection and then every 3 months. Optical coherence tomography scans and fluorescein angiography were performed by the same experienced physician. Repeated intravitreal injections were performed when persistent/recurrent fluid on OCT and/or signs of active CNV on angiography were present. Changes in Early Treatment Diabetic Retinopathy Study visual acuity and central foveal thickness were statistically analyzed.
The mean follow-up time was 70.4 ± 24 weeks (17.6 months; range, 44-116 weeks [11-29 months]). The mean number of injections performed was 2.3, and the mean best-corrected visual acuity improved from 55 Early Treatment Diabetic Retinopathy Study letters (logarithm of the minimum angle of resolution, 0.9 ± 0.4 [mean ± SD]) at baseline to 70.3 Early Treatment Diabetic Retinopathy Study letters (logarithm of the minimum angle of resolution, 0.6 ± 0.4) at the end of the follow-up, a statistically significant change compared with baseline (P < 0.0001). The mean letter gain was 15.3 letters, and best-corrected visual acuity improved in 14 of 16 patients (88%) and remained stable in 2 patients (12.5%) without any patient demonstrating deterioration. The mean central foveal thickness (although not excessively increased at baseline) improved from 285 ± 20 μm at baseline to 233 ± 21 μm (statistically significant compared with baseline, P < 0.0001) at the end of the follow-up. At the end of the follow-up, all patients demonstrated CNV regression, and retinal pigment epithelial atrophy surrounding the regressed CNV was developed in 11 of the 16 eyes (68.8%). During the same period, no CNV recurrence was observed and no injection-related complications such as cataract, retinal detachment, endophthalmitis, or exacerbation of uveitis were noted.
Overall, our findings suggest that intravitreal injections of ranibizumab have shown promising results in visual acuity improvement and a decrease in macular thickness in patients with inflammatory CNV. Of course, further studies are needed to confirm the exact benefit and standardize the optimal treatment regimen.
评估玻璃体腔内注射雷珠单抗（Lucentis）对伴有各种眼部炎症临床实体的脉络膜新生血管膜（CNV）患者的视力和中心凹视网膜厚度的影响。
我们的研究是一项回顾性、非对照、干预性和观察性病例系列研究。对 15 例经重复玻璃体腔内注射雷珠单抗治疗的炎症性 CNV 患者的 16 只眼进行了评估。基础诊断为：弓形体病（n=4）、匐行性脉络膜病变（n=2）、点状内层脉络膜病变（n=5）、多灶性脉络膜炎（MFC，n=3）和硬皮病（n=2）。所有患者均在每次注射后每月进行光学相干断层扫描（OCT）和荧光素血管造影/吲哚青绿血管造影检查，并在随后的 3 个月内每 3 个月进行一次检查。由同一位经验丰富的医生进行 OCT 扫描和荧光素血管造影检查。当 OCT 上存在持续性/复发性液体和/或血管造影上存在活动性 CNV 的迹象时，进行重复的玻璃体腔内注射。对早期糖尿病视网膜病变研究视力和中心凹视网膜厚度的变化进行了统计学分析。
平均随访时间为 70.4±24 周（17.6 个月；范围，44-116 周[11-29 个月]）。平均注射次数为 2.3 次，最佳矫正视力从基线时的 55 个早期糖尿病视网膜病变研究字母（最小分辨角对数，0.9±0.4[均值±标准差]）提高到随访结束时的 70.3 个早期糖尿病视网膜病变研究字母（最小分辨角对数，0.6±0.4），与基线相比有统计学显著改善（P<0.0001）。平均视力提高 15.3 个字母，16 例患者中有 14 例（88%）视力改善，2 例（12.5%）稳定，无任何患者视力恶化。平均中心凹视网膜厚度（虽然基线时未明显增加）从基线时的 285±20μm 改善至随访结束时的 233±21μm（与基线相比有统计学显著差异，P<0.0001）。在随访结束时，所有患者的 CNV 均消退，在 16 只眼中的 11 只（68.8%）中出现了围绕消退的 CNV 的视网膜色素上皮萎缩。在此期间，未观察到 CNV 复发，也未观察到与注射相关的并发症，如白内障、视网膜脱离、眼内炎或葡萄膜炎恶化。
总体而言，我们的研究结果表明，玻璃体腔内注射雷珠单抗在提高视力和减轻黄斑厚度方面对伴有炎症性 CNV 的患者显示出良好的效果。当然，需要进一步的研究来证实确切的益处并规范最佳治疗方案。
