Tran Thi Ha Chau, Querques Giuseppe, Forzy Gerard, Souied Eric H
Department of Ophthalmology, Hôpital Saint Vincent de Paul, Lille, France.
Ophthalmic Surg Lasers Imaging. 2011 Nov-Dec;42(6):498-508. doi: 10.3928/15428877-20110804-04. Epub 2011 Aug 11.
To investigate the relation between visual gain, injection frequency, and the angiographic regression patterns after intravitreal ranibizumab on an as-needed basis in exudative age-related macular degeneration (AMD).
Fifty-nine treatment-naïve patients (68 eyes) were retrospectively analyzed. All patients received three consecutive monthly injections (induction phase) of ranibizumab (0.5 mg/0.05 mL). Based on fluorescein angiography (FA), the choroidal neovascularization (CNV) was judged to present either complete regression (pattern 1), partial regression (pattern 2), stabilization of the lesion size without leakage (pattern 3), stabilization of the lesion size with persistence of leakage (pattern 4), or increased angiographic size (pattern 5).
Mean visual acuity (VA) significantly improved from 48 to 54.3 letters at 1 year after a mean of 5.5 injections (P < .001). Multiple linear regression revealed baseline VA as a predictor of visual gain and the angiographic pattern as a predictor of number of injections. Analysis of variance revealed a significant interaction (F-test [1.67] = 25, P < .001) between the number of injections at 12 months and the regression patterns, as evaluated by FA 1 month after the induction phase. Eyes showing complete CNV regression needed significantly fewer injections than eyes without any angiographic sign of CNV regression (3.4 injections in pattern 1 vs 5.6 injections in pattern 3 [P = .03], and 7 injections in pattern 4 [P < .001], 4.4 injections in pattern 2 vs 7 injections in pattern 4 [P < .001]).
FA may represent a useful tool to adapt the rhythm of visits and intravitreal anti-vascular endothelial growth factor injections in exudative AMD.
研究在湿性年龄相关性黄斑变性（AMD）中，按需玻璃体内注射雷珠单抗后，视力增益、注射频率与血管造影消退模式之间的关系。
对59例初治患者（68只眼）进行回顾性分析。所有患者连续3个月每月注射一次雷珠单抗（0.5 mg/0.05 mL）（诱导期）。根据荧光素血管造影（FA），脉络膜新生血管（CNV）被判定为呈现完全消退（模式1）、部分消退（模式2）、病变大小稳定且无渗漏（模式3）、病变大小稳定但仍有渗漏（模式4）或血管造影显示大小增加（模式5）。
平均5.5次注射后1年，平均视力（VA）从48显著提高到54.3个字母（P <.001）。多元线性回归显示基线视力是视力增益的预测指标，血管造影模式是注射次数的预测指标。方差分析显示，诱导期后1个月通过FA评估，12个月时的注射次数与消退模式之间存在显著交互作用（F检验[1.67]=25，P <.001）。显示CNV完全消退的眼比没有任何CNV消退血管造影迹象的眼所需注射次数显著更少（模式1为3.4次注射，模式3为5.6次注射[P = 0.03]，模式4为7次注射[P <.001]，模式2为4.4次注射，模式4为7次注射[P <.001]）。
FA可能是调整湿性AMD就诊节奏和玻璃体内抗血管内皮生长因子注射的有用工具。
