Department of Ophthalmology, Duke University, Durham, North Carolina 27710, USA.
Ophthalmology. 2013 Sep;120(9):1860-70. doi: 10.1016/j.ophtha.2013.01.073. Epub 2013 May 1.
To describe the effects of treatment for 1 year with ranibizumab or bevacizumab on macular morphology and the association of macular morphology with visual acuity (VA) in eyes with neovascular age-related macular degeneration (AMD).
Prospective cohort study within a randomized clinical trial.
Participants in the Comparison of Age-related Macular Degeneration Treatments Trials.
Participants were assigned randomly to treatment with ranibizumab or bevacizumab on a monthly or as-needed schedule. Optical coherence tomography (OCT), fluorescein angiography (FA), color fundus photography (FP), and VA testing were performed periodically throughout 52 weeks. Masked readers graded images. General linear models were applied to evaluate effects of time and treatment on outcomes.
Fluid type and location and thickness by OCT, size, and lesion composition on FP, FA, and VA.
Intraretinal fluid (IRF), subretinal fluid (SRF), subretinal pigment epithelium fluid, and retinal, subretinal, and subretinal tissue complex thickness decreased in all treatment groups. A higher proportion of eyes treated monthly with ranibizumab had fluid resolution at 4 weeks, and the difference persisted through 52 weeks. At 52 weeks, there was little association between the presence of fluid of any type (without regard to fluid location) and the mean VA. However, at all time points, eyes with residual IRF, especially foveal IRF, had worse mean VA (9 letters) than those without IRF. Eyes with abnormally thin (<120 μm) or thick (>212 μm) retinas had worse VA than those with normal thickness (120-212 μm). At week 52, eyes with larger neovascular lesions or with foveal scar had worse VA than eyes without these features.
Anti-vascular endothelial growth factor (VEGF) therapy reduced lesion activity and improved VA in all treatment groups. At all time points, eyes with residual IRF had worse VA than those without. Eyes with abnormally thin or thick retinas, residual large lesions, and scar also had worse VA. Monthly ranibizumab dosing yielded more eyes with no fluid and an abnormally thin retina, although the long-term significance is unknown. These results have important treatment implications in eyes undergoing anti-VEGF therapy for neovascular AMD.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
描述雷珠单抗或贝伐单抗治疗 1 年对新生血管性年龄相关性黄斑变性（AMD）患者黄斑形态的影响，以及黄斑形态与视力（VA）的相关性。
在一项随机临床试验中进行的前瞻性队列研究。
比较年龄相关性黄斑变性治疗试验的参与者。
参与者随机分配接受每月或按需治疗的雷珠单抗或贝伐单抗。在 52 周内定期进行光学相干断层扫描（OCT）、荧光素血管造影（FA）、眼底彩色照相（FP）和 VA 测试。掩蔽阅读器对图像进行分级。应用广义线性模型评估时间和治疗对结果的影响。
OCT 检测的液体积聚类型和位置及厚度、FP、FA 和 VA 上的病变大小和成分。
所有治疗组的视网膜内液（IRF）、视网膜下液（SRF）、视网膜下色素上皮液以及视网膜、视网膜下和视网膜下组织复合体厚度均降低。每月接受雷珠单抗治疗的眼在 4 周时出现更多的液体积聚消退，这种差异持续到 52 周。在 52 周时，任何类型的液体积聚（不考虑液体积聚的位置）与平均 VA 之间几乎没有相关性。然而，在所有时间点，存在残余 IRF 的眼，特别是黄斑中心凹 IRF，VA 均较无 IRF 的眼差（9 个字母）。视网膜厚度异常薄（<120 μm）或厚（>212 μm）的眼 VA 较正常厚度（120-212 μm）差。在第 52 周时，存在较大新生血管病变或黄斑中心凹瘢痕的眼 VA 较无这些特征的眼差。
抗血管内皮生长因子（VEGF）治疗降低了所有治疗组的病变活动性并改善了 VA。在所有时间点，存在残余 IRF 的眼 VA 较无 IRF 的眼差。视网膜厚度异常薄或厚、残余大病变和瘢痕的眼 VA 也较差。每月雷珠单抗剂量可使更多的眼无液体积聚和视网膜厚度异常薄，但长期意义尚不清楚。这些结果对视神经新生血管性 AMD 接受抗 VEGF 治疗的眼具有重要的治疗意义。
参考文献后可能发现专有或商业披露。
