老年黄斑变性医疗保险患者接受抗血管内皮生长因子治疗后的眼部并发症。
Ocular complications after anti-vascular endothelial growth factor therapy in Medicare patients with age-related macular degeneration.
机构信息
Department of Ophthalmology, Duke Eye Center, Durham, North Carolina, USA.
出版信息
Am J Ophthalmol. 2011 Aug;152(2):266-72. doi: 10.1016/j.ajo.2011.01.053. Epub 2011 Jun 12.
PURPOSE
To determine longitudinal rates of ocular complications after anti-vascular endothelial growth factor (VEGF) treatment for neovascular age-related macular degeneration (AMD) in a nationally representative longitudinal sample.
DESIGN
Retrospective, longitudinal case-control study.
METHODS
Using the Medicare 5% claims database, diagnoses of neovascular AMD and anti-VEGF injections of ranibizumab, bevacizumab, or pegaptanib were identified from International Classification of Diseases and Current Procedural Terminology procedure codes. Six thousand one hundred fifty-four individuals undergoing anti-VEGF treatment for neovascular AMD (total of 40 903 injections) were compared with 6154 matched controls with neovascular AMD who did not undergo anti-VEGF treatment. Propensity score matching was used to match individuals receiving anti-VEGF injections with controls. Rates of postinjection adverse outcomes (endophthalmitis, rhegmatogenous retinal detachment, retinal tear, uveitis, and vitreous hemorrhage) were analyzed by cumulative incidence and Cox proportional hazards model to control for demographic factors and ocular comorbidities.
RESULTS
At the 2-year follow-up, the rates of endophthalmitis per injection (0.09%; P<.01), uveitis (0.11%; P<.01), and vitreous hemorrhage per injection (0.23%; P < .01) were significantly higher in the anti-VEGF treatment group. With Cox proportional hazards modeling, the anti-VEGF treatment group had a 102% higher risk of severe ocular complications overall and a 4% increased risk per injection, both of which were statistically significant (P<.01).
CONCLUSIONS
Rates of endophthalmitis, uveitis, and vitreous hemorrhage were higher in the group treated with anti-VEGF injection than in the control group, although these nevertheless were rare in both groups. The overall risk of severe ocular complications was significantly higher in the anti-VEGF treatment group.
目的
在全国代表性的纵向样本中，确定接受抗血管内皮生长因子 (VEGF) 治疗后新生血管性年龄相关性黄斑变性 (AMD) 的眼部并发症的纵向发生率。
设计
回顾性纵向病例对照研究。
方法
使用医疗保险 5%的索赔数据库，从国际疾病分类和当前程序术语程序代码中确定新生血管性 AMD 和抗 VEGF 雷珠单抗、贝伐珠单抗或康柏西普注射的诊断。6154 名接受抗 VEGF 治疗新生血管性 AMD（共 40903 次注射）的患者与 6154 名未接受抗 VEGF 治疗的匹配新生血管性 AMD 对照者进行比较。采用倾向评分匹配法将接受抗 VEGF 注射的个体与对照者进行匹配。通过累积发病率和 Cox 比例风险模型分析注射后不良结局（眼内炎、孔源性视网膜脱离、视网膜裂孔、葡萄膜炎和玻璃体积血）的发生率，以控制人口统计学因素和眼部合并症。
结果
在 2 年的随访中，抗 VEGF 治疗组的注射后眼内炎（0.09%；P<.01）、葡萄膜炎（0.11%；P<.01）和玻璃体积血（0.23%；P<.01）的发生率明显更高。采用 Cox 比例风险模型，抗 VEGF 治疗组的严重眼部并发症总体风险增加 102%，每注射增加 4%，均具有统计学意义（P<.01）。
结论
与对照组相比，接受抗 VEGF 注射治疗的患者眼内炎、葡萄膜炎和玻璃体积血的发生率更高，但两组均罕见。抗 VEGF 治疗组严重眼部并发症的总体风险显著更高。
Zotero 插件