Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Ophthalmology. 2012 Aug;119(8):1621-7. doi: 10.1016/j.ophtha.2012.02.022. Epub 2012 May 1.
To investigate the changes in subfoveal choroidal thickness after intravitreal injections of ranibizumab (IVRs) for neovascular age-related macular degeneration (AMD).
Prospective, consecutive, interventional case series.
Eighty eyes (40 affected eyes with neovascular AMD and 40 unaffected fellow eyes) of 40 patients.
Forty eyes with neovascular AMD were treated with 0.5-mg IVRs monthly for 3 months and received additional IVRs as needed over the following 9-month period. Subfoveal choroidal thickness in all 80 eyes was measured by use of enhanced depth imaging optical coherence tomography images before and after starting the IVRs.
Changes in subfoveal choroidal thickness after treatment by IVRs over a 12-month period.
Twenty-three eyes (57.5%) were diagnosed with typical neovascular AMD, 16 eyes (40%) were diagnosed with polypoidal choroidal vasculopathy, and 1 eye (2.5%) was diagnosed with retinal angiomatous proliferation. Fifteen eyes (38%) had received some previous treatments for the neovascular lesion before undergoing the IVRs. The mean best-corrected visual acuity of the affected eyes was improved from 0.54 logarithm of the minimum angle of resolution units at baseline to 0.42 at 12 months (P = 0.020). The mean subfoveal choroidal thickness in the affected eyes decreased from 244±62 μm at baseline to 234±66 μm at 1 month (P = 0.013), 226±68 μm at 3 months (P<0.001), 229±67 μm at 6 months (P = 0.002), and 226±66 μm at 12 months (P = 0.002; the change ratio, 93%), whereas that in the unaffected eyes changed from 237±80 μm at baseline to 238±83 μm at 12 months (P = 0.78). In the affected eyes, the change ratio of subfoveal choroidal thickness at 12 months was not correlated with the number of IVRs (mean, 5.8±2.9). Subfoveal choroidal thickness demonstrated a similar trend toward decreasing during the following period independent of the subtypes of neovascular AMD or the treatment histories.
Subfoveal choroidal thickness decreased after IVRs in eyes with neovascular AMD. Intravitreal injections of ranibizumab may provide a pharmacologic effect not only on the neovascular lesion but also on the underlying choroid.
研究玻璃体内注射雷珠单抗（IVR）治疗新生血管性年龄相关性黄斑变性（AMD）后，患者的黄斑中心凹下脉络膜厚度的变化。
前瞻性、连续、干预性病例系列研究。
40 例患者的 80 只眼（40 只患眼伴新生血管性 AMD，40 只对侧眼无病变）。
对 40 只患眼进行了 0.5mg IVR 每月 1 次的治疗，持续 3 个月，随后在接下来的 9 个月内根据需要进行额外的 IVR 治疗。在开始 IVR 治疗前后，使用增强深度成像光学相干断层扫描图像测量所有 80 只眼的黄斑中心凹下脉络膜厚度。
IVR 治疗 12 个月后黄斑中心凹下脉络膜厚度的变化。
23 只眼（57.5%）被诊断为典型新生血管性 AMD，16 只眼（40%）被诊断为息肉样脉络膜血管病变，1 只眼（2.5%）被诊断为视网膜血管瘤样增生。在接受 IVR 治疗之前，15 只眼（38%）已经接受了一些针对新生血管病变的先前治疗。患眼的最佳矫正视力从基线时的 0.54 对数最小角分辨率单位提高到 12 个月时的 0.42（P = 0.020）。患眼的黄斑中心凹下脉络膜厚度从基线时的 244±62μm 降低到 1 个月时的 234±66μm（P = 0.013）、3 个月时的 226±68μm（P<0.001）、6 个月时的 229±67μm（P = 0.002）和 12 个月时的 226±66μm（P = 0.002；变化率为 93%），而对侧眼的厚度从基线时的 237±80μm 增加到 12 个月时的 238±83μm（P = 0.78）。在患眼中，黄斑中心凹下脉络膜厚度在 12 个月时的变化率与 IVR 的数量无关（平均值为 5.8±2.9）。黄斑中心凹下脉络膜厚度在接下来的时间里表现出相似的下降趋势，与新生血管性 AMD 的亚型或治疗史无关。
玻璃体内注射雷珠单抗后，新生血管性 AMD 眼的黄斑中心凹下脉络膜厚度降低。玻璃体内注射雷珠单抗不仅对新生血管病变，而且对脉络膜的潜在组织都有药理作用。
