Laser and Imaging Ophthalmology Center, Paris, France.
Retina. 2012 Sep;32(8):1480-5. doi: 10.1097/IAE.0b013e318240a516.
To identify the causes of loss of vision after ranibizumab therapy in patients with exudative age-related macular degeneration treated in three clinical settings.
A retrospective multicentric analysis of 290 consecutive eyes comprising cohorts from 3 clinical settings showed that 21 eyes lost ≥ 15 letters on the Early Treatment Diabetic Retinopathy Study chart 1 year after the start of ranibizumab treatment. Fundus images of these eyes were analyzed by two independent readers to investigate the causes of visual loss. The three cohorts were compared. A search was made for factors predisposing to visual loss. A second analysis was performed to compare the baseline characteristics of patients who gained (visual acuity gainers) or lost (visual acuity losers) ≥ 15 letters.
Among the 290 eyes included, the proportions from each center experiencing visual loss were not significantly different (mean, 7.24%, P = 0.2631). Mean visual loss of affected eyes was 27 letters. There was no significant difference between these eyes and others as regards age and gender of patients, laterality, type of choroidal neovascularization, number of visits, or initial visual acuity. Visual loss was secondary to the progression of atrophy in eight eyes, fibrosis in five eyes, a combination of fibrosis and atrophy in three eyes, severe subretinal hemorrhage in three eyes, and retinal pigment epithelial tear in two eyes. A significant difference between visual acuity gainers and losers was observed for 2 parameters: age of patients, 80.9 ± 5.3 years in visual acuity losers versus 77.5 ± 7.3 years in visual acuity gainers (P = 0.0473) and visual acuity at diagnosis, respectively, 56.2 ± 11.2 versus 49.0 ± 12.0 (P = 0.0288).
Although uncommon, visual loss may occur during ranibizumab treatment and is because of the natural course of age-related macular degeneration in most cases.
在三个临床环境中接受雷珠单抗治疗的渗出性年龄相关性黄斑变性患者中，确定雷珠单抗治疗后视力丧失的原因。
对来自三个临床环境的三个队列的 290 只连续眼进行回顾性多中心分析，结果表明，21 只眼在开始雷珠单抗治疗后 1 年时，最佳矫正视力（BCVA）丧失≥15 个字母。通过两位独立的读者对这些眼的眼底图像进行分析，以调查视力丧失的原因。比较了这三个队列。寻找导致视力丧失的易患因素。进行了第二次分析，比较了视力提高（视力提高者）或视力丧失（视力丧失者）≥15 个字母的患者的基线特征。
在纳入的 290 只眼中，来自每个中心的视力丧失比例无显著差异（平均为 7.24%，P=0.2631）。受影响眼的平均视力丧失为 27 个字母。这些眼与其他眼在患者年龄和性别、侧别、脉络膜新生血管的类型、就诊次数或初始视力方面无显著差异。8 只眼的视力丧失继发于萎缩进展，5 只眼继发于纤维化，3 只眼为纤维化和萎缩的组合，3 只眼继发于严重的视网膜下出血，2 只眼继发于视网膜色素上皮撕裂。视力丧失者和保留者之间有两个参数有显著差异：患者年龄，视力丧失者为 80.9±5.3 岁，视力保留者为 77.5±7.3 岁（P=0.0473）和诊断时的视力，分别为 56.2±11.2 与 49.0±12.0（P=0.0288）。
尽管不常见，但雷珠单抗治疗期间可能会发生视力丧失，且在大多数情况下是年龄相关性黄斑变性自然病程的结果。
