Ophthalmology Department, University of Lausanne, Jules-Gonin Eye Hospital, Lausanne, Switzerland.
Graefes Arch Clin Exp Ophthalmol. 2011 Nov;249(11):1635-42. doi: 10.1007/s00417-011-1734-5. Epub 2011 Jul 2.
The aim of this work is to investigate the characteristics of eyes failing to maintain visual acuity (VA) receiving variable dosing ranibizumab for neovascular age-related macular degeneration (nAMD) after three initial loading doses.
A consecutive series of patients with nAMD, who, after three loading doses of intravitreal ranibizumab (0.5 mg each), were re-treated for fluid seen on optical coherence tomography. After exclusion of eyes with previous treatment, follow-up less than 12 months, or missed visits, 99 patients were included in the analysis. The influence of baseline characteristics, initial VA response, and central retinal thickness (CRT) fluctuations on the VA stability from month 3 to month 24 were analyzed using subgroups and multiple regression analyses.
Mean follow-up duration was 21.3 months (range 12-40 months, 32 patients followed-up for ≥24 months). Secondary loss of VA (loss of five letters or more) after month 3 was seen in 30 patients (mean VA improvement from baseline +5.8 letters at month 3, mean loss from baseline -5.3 letters at month 12 and -9.7 at final visit up to month 24), while 69 patients maintained vision (mean gain +8.9 letters at month 3, +10.4 letters at month 12, and +12.8 letters at final visit up to month 24). Secondary loss of VA was associated with the presence of pigment epithelial detachment (PED) at baseline (p 0.01), but not with baseline fibrosis/atrophy/hemorrhage, CRT fluctuations, or initial VA response. Chart analysis revealed additional individual explanations for the secondary loss of VA, including retinal pigment epithelial tears, progressive fibrosis, and atrophy.
Tissue damage due to degeneration of PED, retinal pigment epithelial tears, progressive fibrosis, progressive atrophy, or massive hemorrhage, appears to be relevant in causing secondary loss of VA despite vascular endothelial growth factor suppression. PED at baseline may represent a risk factor.
本研究旨在探讨初始三次负荷剂量玻璃体内注射雷珠单抗（0.5mg 每次）治疗后，仍无法维持视力（VA）的新生血管性年龄相关性黄斑变性（nAMD）患者的眼部特征。
本研究为一项连续系列病例研究，纳入了初始三次负荷剂量治疗后，因光学相干断层扫描显示有液体而再次接受治疗的 nAMD 患者。排除了既往治疗史、随访时间＜12 个月和失访的患者后，共纳入 99 例患者进行分析。采用亚组分析和多元回归分析，评估基线特征、初始 VA 反应和中心视网膜厚度（CRT）波动对第 3 至 24 个月 VA 稳定性的影响。
平均随访时间为 21.3 个月（范围 12-40 个月，32 例患者的随访时间≥24 个月）。第 3 个月后出现 VA 二次损失（损失 5 个字母或更多）的患者有 30 例（第 3 个月时平均 VA 从基线改善+5.8 个字母，第 12 个月时从基线损失-5.3 个字母，最终随访时直至第 24 个月损失-9.7 个字母），而 69 例患者保持了视力（第 3 个月时平均提高+8.9 个字母，第 12 个月时提高+10.4 个字母，最终随访时直至第 24 个月提高+12.8 个字母）。VA 二次损失与基线时存在色素上皮脱离（PED）相关（p=0.01），但与基线纤维化/萎缩/出血、CRT 波动或初始 VA 反应无关。图表分析还发现了 VA 二次损失的其他个体解释，包括视网膜色素上皮撕裂、进行性纤维化和萎缩。
尽管血管内皮生长因子受到抑制，但 PED 变性、视网膜色素上皮撕裂、进行性纤维化、进行性萎缩或大量出血引起的组织损伤似乎是导致 VA 二次损失的原因。基线时的 PED 可能是一个危险因素。
