Department of Ophthalmology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Graefes Arch Clin Exp Ophthalmol. 2012 Sep;250(9):1283-92. doi: 10.1007/s00417-012-1955-2. Epub 2012 Feb 21.
To review vascularized-pigment epithelial detachment (V-PED) treatment visual outcome, and to assess acute retinal pigment epithelium (RPE) tear incidence.
One hundred and thirty-two eyes of 125 consecutive patients with age-related macular degeneration and V-PED were included. Ninety-four eyes (71.2%) were associated with choroidal new vessels (CNV), 38 (28.8%) with retinal angiomatous proliferation (RAP). Patients, treated over a 10-year period with the time-current therapy, received: verteporfin photodynamic therapy (PDT) (group 1, 38 eyes), combined intravitreal triamcinolone acetonide (IVTA) and PDT (group 2, 44 eyes) or intravitreal anti-VEGF injection (bevacizumab or ranibizumab) (group 3, 50 eyes).
Mean follow-up was 20.5 months. At month 12, all eyes treated with PDT or with IVTA and PDT showed a mean significant severe visual decrease. Eyes with CNV lost -0.67 and -0.37 logMAR (p < 0.01 and p < 0.01 respectively), and eyes with RAP -0.55 and -0.31 logMAR (p < 0.01 and p = 0.01 respectively). RPE tear occurred in 14 eyes (36.8%) and in six eyes (13.6%) in groups 1 and 2 respectively. Eyes treated with anti-VEGF therapy showed slight mean visual acuity decrease at month 12. Those with CNV had a mean baseline best-corrected visual acuity (BCVA) of 0.36 ± 0.24 logMAR, final of 0.44 ± 0.30 logMAR (-0.08 logMAR, n.s.). In eyes with RAP, mean baseline BCVA was 0.58 ± 0.39 logMAR, final was 0.78 ± 0.47 logMAR (-0.20 logMAR, n.s.). RPE tear occurred in 14 eyes (36.8%). Patients with either V-PED with CNV or a better baseline BCVA showed greater risk of acute RPE tear (p = 0.01 and p = 0.003 respectively).
Effective treatment for vascularized PED is still lacking. Until now, only stabilization of the disease has been achieved using anti-VEGF therapy, but the risk of RPE tear can further hamper our expectations. Baseline characteristics are helpful for prognosis, but patients must be informed of the uncertain response. New therapeutic strategies are needed.
回顾血管化色素上皮脱离（V-PED）的治疗结果，评估急性视网膜色素上皮（RPE）撕裂的发生率。
纳入了 125 例年龄相关性黄斑变性伴 V-PED 的连续患者的 132 只眼。94 只眼（71.2%）与脉络膜新生血管（CNV）有关，38 只眼（28.8%）与视网膜血管瘤样增殖（RAP）有关。在 10 年的时间里，患者接受了时电流疗法的治疗：维替泊芬光动力疗法（PDT）（第 1 组，38 只眼）、联合玻璃体内曲安奈德（IVTA）和 PDT（第 2 组，44 只眼）或玻璃体内抗血管内皮生长因子注射（贝伐单抗或雷珠单抗）（第 3 组，50 只眼）。
平均随访时间为 20.5 个月。在第 12 个月时，所有接受 PDT 或 IVTA 和 PDT 治疗的眼睛均出现了明显的严重视力下降。CNV 眼的视力分别下降了-0.67 和-0.37 logMAR（p < 0.01 和 p < 0.01），RAP 眼的视力分别下降了-0.55 和-0.31 logMAR（p < 0.01 和 p = 0.01）。14 只眼（36.8%）和 6 只眼（13.6%）分别发生了 RPE 撕裂，分别发生在第 1 组和第 2 组。接受抗 VEGF 治疗的眼睛在第 12 个月时出现了轻微的平均视力下降。CNV 眼的平均基线最佳矫正视力（BCVA）为 0.36 ± 0.24 logMAR，最终为 0.44 ± 0.30 logMAR（-0.08 logMAR，无统计学意义）。RAP 眼的平均基线 BCVA 为 0.58 ± 0.39 logMAR，最终为 0.78 ± 0.47 logMAR（-0.20 logMAR，无统计学意义）。14 只眼（36.8%）发生了 RPE 撕裂。患有 CNV 的 V-PED 或基线 BCVA 较好的患者发生急性 RPE 撕裂的风险更高（p = 0.01 和 p = 0.003）。
目前，针对血管化 PED 的有效治疗方法仍然缺乏。到目前为止，只有使用抗 VEGF 治疗才能稳定疾病，但 RPE 撕裂的风险可能会进一步影响我们的预期。基线特征有助于预后，但必须告知患者治疗效果不确定。需要新的治疗策略。
