Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, Philadelphia, Pennsylvania 19104, USA.
Ophthalmology. 2013 Jan;120(1):122-9. doi: 10.1016/j.ophtha.2012.07.042. Epub 2012 Oct 6.
To determine the baseline predictors of visual acuity (VA) outcomes 1 year after treatment with ranibizumab or bevacizumab for neovascular age-related macular degeneration (AMD).
Cohort study within the Comparison of Age-related Macular Degeneration Treatments Trials (CATT).
A total of 1105 participants with neovascular AMD, baseline VA 20/25 to 20/320, and VA measured at 1 year.
Participants were randomly assigned to ranibizumab or bevacizumab on a monthly or as-needed schedule. Masked readers evaluated fundus morphology and features on optical coherence tomography (OCT). Visual acuity was measured using electronic VA testing. Independent predictors were identified using regression techniques.
The VA score, VA score change from baseline, and ≥3-line gain at 1 year.
At 1 year, the mean VA score was 68 letters, mean improvement from baseline was 7 letters, and 28% of participants gained ≥3 lines. Older age, larger area of choroidal neovascularization (CNV), and elevation of retinal pigment epithelium (RPE) were associated with worse VA (all P<0.005), less gain in VA (all P<0.02), and a lower proportion gaining ≥3 lines (all P<0.04). Better baseline VA was associated with better VA at 1 year, less gain in VA, and a lower proportion gaining ≥3 lines (all P<0.0001). Predominantly or minimally classic lesions were associated with worse VA than occult lesions (66 vs. 69 letters; P=0.0003). Retinal angiomatous proliferans (RAP) lesions were associated with more gain in VA (10 vs. 7 letters; P=0.03) and a higher proportion gaining ≥3 lines (odds ratio, 1.9; 95% confidence interval, 1.2-3.1). Geographic atrophy (GA) was associated with worse VA (64 vs. 68 letters; P=0.02). Eyes with total foveal thickness in the second quartile (325-425 μm) had the best VA (P=0.01) and were most likely to gain ≥3 lines (P=0.004). Predictors did not vary by treatment group.
For all treatment groups, older age, better baseline VA, larger CNV area, predominantly or minimally classic lesion, absence of RAP lesion, presence of GA, greater total fovea thickness, and RPE elevation on optical coherence tomography were independently associated with less improvement in VA at 1 year.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
确定雷珠单抗或贝伐单抗治疗新生血管性年龄相关性黄斑变性（AMD） 1 年后视力（VA）结局的基线预测因素。
比较年龄相关性黄斑变性治疗试验（CATT）中的队列研究。
共纳入 1105 名患有新生血管性 AMD 的患者，基线 VA 为 20/25 至 20/320，VA 于 1 年时测量。
参与者根据每月或按需方案随机分配接受雷珠单抗或贝伐单抗治疗。盲法读者评估眼底形态和光学相干断层扫描（OCT）上的特征。使用电子 VA 测试测量视力。使用回归技术确定独立预测因素。
VA 评分、从基线的 VA 评分变化和 1 年时 ≥3 行获益。
1 年后，平均 VA 评分为 68 个字母，基线改善平均为 7 个字母，28%的参与者获得≥3 行获益。年龄较大、脉络膜新生血管（CNV）面积较大和视网膜色素上皮（RPE）抬高与 VA 较差（均 P<0.005）、VA 获益较少（均 P<0.02）和获得≥3 行获益的比例较低（均 P<0.04）相关。基线 VA 较好与 1 年后 VA 较好、VA 获益较少和获得≥3 行获益的比例较低相关（均 P<0.0001）。与隐匿性病变相比，主要或轻微经典病变与 VA 较差相关（66 与 69 个字母；P=0.0003）。视网膜血管瘤样增生（RAP）病变与 VA 获益更多（10 与 7 个字母；P=0.03）和获得≥3 行获益的比例更高（优势比，1.9；95%置信区间，1.2-3.1）相关。地理萎缩（GA）与 VA 较差相关（64 与 68 个字母；P=0.02）。总黄斑中心凹厚度处于第二四分位数（325-425μm）的眼具有最佳 VA（P=0.01），最有可能获得≥3 行获益（P=0.004）。预测因素不因治疗组而异。
对于所有治疗组，年龄较大、基线 VA 较好、CNV 面积较大、主要或轻微经典病变、无 RAP 病变、存在 GA、总黄斑中心凹厚度较大和 OCT 上的 RPE 抬高与 1 年后 VA 改善较少独立相关。
